Original Research

Mental health stigma and help-seeking intentions in police employees

Daniel W. Grupe^*

ABSTRACT

Mental health problems among police employees are exacerbated by negative attitudes and beliefs around mental health help-seeking that are perpetuated by police culture. We collected anonymous survey data from 257 civilian and commissioned police employees in a mid-sized, Midwestern U.S. city to test hypothesized relationships among help-seeking stigma, help-seeking attitudes, and intended help-seeking behaviour. Results demonstrated that mental health help-seeking stigma was negatively associated with help-seeking attitudes, and in turn with reduced mental health help-seeking intentions. Structural equation modeling provided support for a model linking help-seeking stigma, help-seeking attitudes, and intentions to seek help. This path model was moderated by psychological distress and previous participation in mindfulness training, which had opposing effects on help-seeking stigma and (indirectly) on intended help-seeking. Results provide insight into policies, practices, and interventions that police agencies may enact to combat stigma, positively influence mental health help-seeking, and improve the mental health and well-being of police employees and the broader community.

Key Words: Perceived stigma, self-stigma, mindfulness, psychological distress

INTRODUCTION

High rates of mental health difficulties among police professionals are well documented and have widespread negative consequences. A national Canadian survey found that 37% of municipal and provincial police officers and 50% of federal officers screened positive for a mental health disorder (Carleton et al., 2017). A separate meta-analysis reported rates of 15% for posttraumatic stress disorder (PTSD), 14% for depression, 11% for generalized anxiety disorder, and 25% for hazardous drinking (Syed et al., 2020). Psychological distress is accompanied by restricted attention, self-regulatory difficulties, fatigue, and increased anger and aggression, all of which impede officers’ ability to bring clear thinking, careful attention, and empathic, non-discriminatory responses to community members in need (Goff & Rau, 2020; Ma et al., 2013; Rajaratnam et al., 2011). Enhancing police mental health is essential for the well-being of those in the profession and the broader community.

Police culture plays a key role in this mental health crisis (Tuckey et al., 2012). Police officers are socialized to maintain control over emotions lest they interfere with decision-making, performance, or career advancements (Karaffa & Koch, 2016; Karaffa & Tochkov, 2013; Tuckey et al., 2012). Acknowledging emotional difficulties or offering emotional support runs counter to traditional ideals of masculinity, leading to shame or ridicule by one’s peers (Pasciak & Kelley, 2013). Seeking help for mental health challenges may raise questions about one’s fitness for duty (Drew & Martin, 2021). As a result, police officers often avoid or suppress emotions that are a natural response to the stress and trauma of their work, often coping with these emotions by abusing alcohol or other drugs or engaging in other destructive behaviours (Karaffa & Tochkov, 2013; Pasciak & Kelley, 2013; Rees & Smith, 2008).

Previous research (Vogel et al., 2007) suggests a pathway that discourages individuals experiencing psychological distress from seeking out mental health support (Figure 1). “Public stigma”—or culturally transmitted messages that mental health help-seeking is undesirable or unacceptable—can become internalized as “self-stigma,” or one’s personally held beliefs about the social unacceptability of seeking help and the negative impact of help-seeking on one’s self-worth. Self-stigma is proposed to negatively affect specific attitudes about seeking help, which in turn discourages help-seeking behaviour. Research utilizing qualitative (Marin, 2012; Newell et al., 2022; Ricciardelli et al., 2020) and quantitative (Drew & Martin, 2021; Wester et al., 2010) methods has demonstrated that public stigma and self-stigma are powerful barriers to help-seeking intentions among police officers. Further, research with police officers validated portions of the Vogel et al. (2007) model initially validated in undergraduate students, demonstrating that self-stigma mediated the relationship between perceived public stigma and treatment-seeking attitudes (Karaffa & Koch, 2016). This suggests that stigma-reducing interventions may improve police officers’ attitudes about seeking help, but the researchers did not investigate the impact of negative help-seeking attitudes on help-seeking intentions, as has been demonstrated in non-police populations (Li et al., 2014).

The primary goal of this study was to validate this model of mental health help-seeking intentions (Vogel et al., 2007) in a law enforcement population. By replicating previous findings relating stigma to help-seeking attitudes (Karaffa & Koch, 2016), and extending results to encompass intentions to seek help, this research may indicate proximal targets for interventions with the long-term goal of increased help-seeking and improved mental health outcomes. In contrast to prior research (Karaffa & Koch, 2016), the current study includes civilian employees, who are often overlooked in police mental health research despite reporting similar or higher rates of burnout, anxiety, and depression as commissioned personnel (McCarty & Skogan, 2013; Carleton et al., 2017; Lentz et al., 2020). The secondary goal was to investigate moderators of help-seeking intentions, including demographic characteristics, self-reported psychological distress, and past exposure to mindfulness training. Mounting evidence suggests mindfulness training has broad physical and mental health benefits for policing (Christopher et al., 2018; Grupe, Stoller, et al., 2021), and it may be less stigmatizing than interventions focused on symptom reduction due to its preventive, strength-based approach to promoting well-being. Moderator analyses highlight individual differences that may influence the pathway linking stigma, attitudes, and help-seeking intentions, thus facilitating the development of tailored help-seeking interventions among police employees.

METHODS

Pre-Registration

Hypotheses and data collection and analysis plans were pre-registered prior to data collection in May 2020 on the Open Science Framework (https://osf.io/zyk9d). The pre-registration included analyses investigating the impact of mandatory wellness checks on variables of interest, but this paper focuses on data from a single time point (due to the elimination of wellness checks following departmental budget cuts).

Participants and Recruitment

Study procedures were approved by the University of Wisconsin- Madison Minimal Risk Institutional Review Board. All employees of the Madison Police Department, Fitchburg Police Department, and University of Wisconsin-Madison Police Department (all in Dane County, WI, USA) were invited to participate in this research (the Fitchburg Department was added after pre-registration to increase sample size). The study was advertised across shift changes and in e-mails distributed to all employees over a 2-week period in May 2020. Notably, this research took place as agencies were adapting to rapidly changing operational conditions in the early months of the COVID-19 pandemic. Additionally, the end of data collection took place in the days following the murder of George Floyd by former Minneapolis police officer Derek Chauvin on May 25 (only 7/257 responses were obtained after May 25).

Data Collection

Recruitment e-mails included a link to a description of study procedures, informed consent language, and survey questions using the Qualtrics platform. Complete information on survey measures is provided in Supplemental Methods. Briefly, surveys included:

• ■ Demographics and job information.

• ■ Patient-Reported Outcomes Measurement Information System, 29-item version (PROMIS-29; Hays et al., 2018), from which we analyzed anxiety and depression subscales.

• ■ Perceived Stress Scale, 10-item version (PSS-10; Cohen & Williamson, 1988).

• ■ Perceived Stigma and Barriers to Care for Psychological Problems (Britt & Cox, 2008), which includes a measure of perceived public stigma of help-seeking.

• ■ Self-Stigma of Seeking Help Scale (Vogel et al., 2006), which reflects the internalization of perceived public stigma.

• ■ Mental Help Seeking Attitudes Scale (Hammer et al., 2018), which reflects one’s general perceptions (positive or negative) of mental health counseling.

• ■ Past and future utilization of mental health resources. This in-house measure, adapted from previous research with Canadian public safety personnel (Carleton et al., 2020), lists 14 resources for mental health support and asks how many participants had previously utilized or would consider utilizing them in the future.

• ■ Previous mindfulness training. Participants indicated whether they had participated in an 8-week mindfulness training offered to commissioned personnel as part of prior research (Grupe, Smith, et al., 2021; Grupe, Stoller, et al., 2021).

We also included questions about agency culture and climate, and experiences related to COVID-19, which were not analyzed here (see Supplemental Methods).

Data Analysis

Statistical analysis was conducted using RStudio (version 1.2.5042; RStudio Team, 2020) in the R programming environment (version 3.6.3; R Core Team, 2020). Linear regression analyses using the lm() library were used to test pre-registered hypotheses regarding factors associated with help-seeking attitudes, previous utilization of mental health resources, and help-seeking intentions. Regression analyses included covariates of agency, civilian/commissioned status, gender, and years of experience. In addition to regression models for individual dependent variables, we used the lavaan() library (Rosseel, 2011) to conduct a path analysis testing the fit of a model linking perceived help-seeking stigma, self-stigma, help-seeking attitudes, and help-seeking intentions (Lin, 2021; Figure 1). To test hypothesized moderators, we constructed a model with exogenous variables corresponding to prior mindfulness training and psychological distress symptoms. Psychological distress was operationalized as the standardized sum score of the PSS-10 and PROMIS anxiety/depression scores. See Supplemental Methods for full data analysis details.

RESULTS

Table I includes information on demographics and work. Across all agencies, 257 individuals provided informed consent, including 189 commissioned and 68 civilian staff. This represents approximately 20 to 30% of employees from each of these agencies, and generally reflects the ratio of civilian/commissioned staff in these departments. Table II contains descriptive information for self-report measures. Notably, civilian staff reported higher levels of perceived stress (t(250) = 2.27, p = 0.024, 95% confidence interval [CI] [0.28, 3.89]), anxiety (t(250) = 3.66, p < 0.001, 95% CI [1.78, 5.87]), and depression than commissioned staff (t(250) = 3.95, p < 0.001, 95% CI [2.26, 6.75]). See Supplemental Results for other commissioned/civilian differences.

TABLE I Participant demographics and job characteristics*

TABLE II Descriptive information for self-report questionnaires*

Mental Health Stigma and Help-Seeking Attitudes

Controlling for agency, civilian/commissioned status, gender, and years of experience, perceived public help-seeking stigma was negatively associated with help-seeking attitudes (r_partial(249) = −0.36, 95% CI [−0.46, −0.25], p < 0.001; Figure 2A). A more robust relationship was observed for self-stigma and attitudes toward mental health help-seeking (r_partial(249) = −0.63, 95% CI [−0.70, −0.55], p < 0.001; Figure 2B). A mediation analysis using lavaan demonstrated the relationship between perceived public stigma and help-seeking attitudes was fully mediated by self-stigma (total effect estimate = −0.053, p < 0.001, 95% CI [−0.069, −0.037]; direct effect estimate = 0.00, p = 0.99, 95% CI [−0.017, 0.018]; indirect effect estimate = −0.053, p < 0.001, 95% CI [−0.070, −0.040]; Figure 2C). Generally consistent with hypotheses, prior mindfulness training was associated (at trend-level) with reduced perceived public stigma and more positive help-seeking attitudes (but not self-stigma), and greater psychological distress was associated with greater perceived public stigma, greater self-stigma, and more negative help-seeking attitudes (see Supplemental Results for details).

Help-Seeking Attitudes and Intended Help-Seeking Behaviour

A novel questionnaire created for this study listed 14 resources police employees might seek out for mental health support. On average, participants reported utilizing 6.3 of these resources in their lifetime (range = 0–13) and 4.1 of these resources over the past 12 months (range = 0–10; Table III and Supplemental Results). To operationalize past and future (intended) mental health help-seeking, we tallied how many resources participants utilized in the past 12 months, and those they “might” or “would definitely” consider utilizing in the future. Controlling for agency, civilian/commissioned status, age, and years of police service, help-seeking attitudes were positively associated with utilization of mental health support in the past 12 months (r_partial(248) = 0.28, 95% CI [0.16, 0.39], p < 0.001; Figure 3A). A statistically stronger relationship was observed between help-seeking attitudes and future help-seeking intentions (r_partial(247) = 0.45, 95% CI [0.35, 0.55], p < 0.001; difference between correlations: William’s t(246) = 2.48, p = 0.01; Figure 3B). Consistent with hypotheses, prior mindfulness training was associated with greater past and intended utilization of mental health resources. Greater psychological distress was associated with greater past resource utilization but lower intended future resource utilization (see Supplemental Results for details).

TABLE III Percentage of all staff, civilian staff, and sworn staff who indicated that they had utilized specific mental health resources*

Path Analysis of Mental Health Help-Seeking Stigma, Attitudes, and Intentions

Using lavaan, we modeled the path analysis depicted in Figure 1, with exogenous variables of civilian/commissioned status, age, and years of police service (police agency was weakly associated with all endogenous variables, all p values > 0.4, and was excluded from the model). Fit indices suggested this model fit the data well (χ²(3) = 6.420, p = 0.093; comparative fit index [CFI] = 0.988; Tucker-Lewis Index [TLI] = 0.927; root mean square error of approximation [RMSEA] = 0.068, p = 0.268; Akaike Information Criterion [AIC] = 5059). We added a direct path from perceived public stigma to intended mental health help-seeking, as suggested by a high modification index using the modindices() function. The resulting model had improved fit indices (χ²(2) = 0.086, p = 0.958; CFI = 1.000; TLI = 1.000; RMSEA = 0.000, p = 0.977; AIC = 5054), and is shown in Figure 4A.

An additional model included prior mindfulness training and psychological distress as potential moderators. This model fit the data excellently (χ²(8) = 4.563, p = 0.803; CFI = 1.000; TLI = 1.000; RMSEA = 0.000, p = 0.957; AIC = 5021; Figure 4B). Examination of individual pathways showed significant direct effects of psychological distress (Z = 6.07, b = 3.25, p < 0.001) and prior mindfulness training on perceived public stigma (Z = −2.21, b = −2.52, p = 0.03). Psychological distress was indirectly associated with lower intended help-seeking through increased perceived public stigma, whereas prior mindfulness training was indirectly associated with higher intended help-seeking through decreased perceived public stigma.

DISCUSSION

Results of this cross-sectional study in 257 commissioned and civilian police employees provide support for a pathway in which perceived public help-seeking stigma becomes internalized as self-stigma, leading to negative help-seeking attitudes and reduced intentions to seek mental health support. These findings underscore the importance of perceived public stigma—police employees’ beliefs about what others might think if they sought out mental health support—for help-seeking intentions. In previous research, police officers underestimated the extent to which coworkers wanted to seek help for mental health concerns (Karaffa & Koch, 2016) and believed that others were less interested in seeking help than they were themselves (Karaffa & Tochkov, 2013). Individuals may not recognize that coworkers’ behaviours and attitudes around help-seeking reflect a desire to fit in with the group, as opposed to personally held beliefs and values. By highlighting this discrepancy between perceptions and realities of attitudes about help-seeking, police organizations may be able to correct erroneous beliefs of “what everybody else thinks” and shift both group norms and individual attitudes about seeking help (Karaffa & Koch, 2016). This combination of group norms and individual attitudes is posited to influence intentions to engage in behaviour change (Azjen & Fishbein, 1980), and our finding that help-seeking attitudes were associated with increased help-seeking intentions suggests that correcting erroneous attitudes and beliefs about help-seeking may encourage greater help-seeking behaviour across the organization.

Stigma, Help-Seeking, and Policing

Moving the needle on perceived help-seeking stigma is challenging in a culture that strongly values stoicism and views emotional difficulties as a sign of weakness (Drew & Martin, 2021; Tuckey et al., 2012). Fortunately, our results suggest that changing beliefs about help-seeking may not require changes in widespread cultural beliefs. Our finding that the negative impact of perceived public stigma on help-seeking attitudes was fully mediated by self-stigma—replicating previous research in undergraduate (Vogel et al., 2007) and police samples (Karaffa & Koch, 2016)—suggests that interventions targeting self-stigma around help-seeking can change help-seeking attitudes, which represent the most proximal factor for intended behaviour change (Azjen & Fishbein, 1980). A report commissioned through the 2017 Law Enforcement Mental Health and Wellness Act (Spence et al., 2019) suggested regular mental health check-ins could help destigmatize the help-seeking experience and encourage additional help-seeking behaviour, particularly if made mandatory for all employees and not just those perceived as having “a problem.” The same report, however, also noted the absence of empirical support for the impact of these check-ins.

Opposing Influences of Mindfulness and Distress on Help-Seeking Intentions

A “foundational step” for increasing mental health help-seeking, argue Drew and Martin (2021), is normalizing the negative emotions that arise in an environment full of trauma, loss, and human suffering. Acknowledging and talking about these natural emotional responses, rather than avoiding or suppressing emotions to project a façade of strength and control, may encourage help-seeking when the impact of occupational stress and trauma becomes overwhelming. Engaging in these conversations in a supportive group setting with one’s peers may be especially helpful in normalizing these experiences and reducing help-seeking stigma. Indeed, we found that previous participation in an 8-week, group-based mindfulness training was a significant moderator of the path proceeding from perceived public stigma to help-seeking intentions. Mindfulness practices support greater awareness of internal sensations, emotions, and thoughts and encourage curiosity and acceptance of challenging experiences, rather than avoidance or suppression. These data are correlational, and mindfulness participants may have entered the training with lower levels of stigma or more positive help-seeking attitudes than their peers; prospective designs are needed to establish a causal role of mindfulness for promoting mental health help-seeking.

In contrast to relationships with mindfulness training, greater psychological distress was associated with greater perceived stigma and reduced help-seeking intentions. Elevated stigma among those with more mental health symptoms presents a paradox for encouraging help-seeking. Mental health interventions may need to be framed in terms of skill-building or as addressing less stigmatized needs (e.g., improving sleep or strengthening relationships) to effectively engage these individuals. Notably, participants generally reported greater interest in seeking support from family, friends, and peers as opposed to mental health professionals (Table III). Providing members of these networks with resources or knowledge about how to effectively provide mental health support could be a valuable intervention strategy that circumvents the barrier of help-seeking stigma.

Civilian Police Employees and Help-Seeking

Civilian employees, representing 25% of our sample, reported significantly greater levels of psychological distress than commissioned staff, consistent with previous results from the few studies that have included civilian personnel (Carleton et al., 2017; Lentz et al., 2020; McCarty & Skogan, 2013). Civilian employees also endorsed fewer mental health resources they would seek out in the future (Table III and Supplemental Results), but it is also the case that some resources are only available to commissioned staff in these agencies (e.g., peer support, critical incident debriefing). This snapshot of group differences highlights the importance of including both civilian and commissioned staff in future mental health research to shed light on the unique and shared needs of all members of the organization.

Limitations

This study included multiple police departments and civilian as well as commissioned staff, yet generalizability is limited by the constrained geographical representation of the sample and self-selection bias. The sample’s relative racial and ethnic homogeneity—representative of the agencies invited to participate—limits generalizability to non-white police employees. Another limitation is the use of a novel, unvalidated help-seeking measure that quantifies the number and type of resources participants would seek out rather than their likelihood of seeking help using a validated help-seeking scale (e.g., Cash et al., 1975). This decision increases external validity and relevance to our collaborating agencies but reduces internal validity. Finally, a prospective design is needed to establish a causal relationship between mindfulness training and help-seeking intentions, and the specificity of this relationship is unknown; perhaps officers engaging in any kind of wellness initiative might report increased help-seeking intentions.

CONCLUSION

One implication of these results for police agencies is the value of multi-level interventions for increasing mental health help-seeking. Individually focused interventions to reduce self-stigma must be paired with organizational messaging about the importance of acknowledging difficulties and seeking help, which can reduce perceived public stigma. Stigma-reducing interventions are most effective when based on social contact and first-person narratives and supported by a long-term organizational commitment (Thornicroft et al., 2016). For meaningful organizational and cultural changes to occur, management and direct supervisors must provide clear, consistent, and personal communication that normalizes conversations about mental health and makes clear the protections in place for employees who seek help.

More broadly, interventions to increase help-seeking behaviour should be considered a core element of police reform, as police mental health is inextricable from the mental health, well-being, and physical safety of the entire community. As the author and therapist Resmaa Menakem writes, “It’s hard to keep the peace when your own body is constricted, unsettled, stressed, and traumatized” (Menakem, 2017, p. 125). Community safety and well-being necessitates the development of novel strategies to reduce help-seeking stigma, promote individualized and culturally appropriate mental health supports, and help police professionals address the unresolved and unmetabolized trauma that too often results in tragedy. This work affects community members and police practitioners alike, and identifying creative solutions necessitates collaboration among these groups to ensure these solutions are of mutual benefit.

ACKNOWLEDGEMENTS

Thank you to our study participants and liaisons from each of our partner agencies, including the Madison Police Department (Captain Mindy Winter), the University of Wisconsin-Madison Police Department (Captain Mark Silbernagel), and the Fitchburg Police Department (Chief Chad Brecklin). DWG was supported by a Career Development Award from the National Institute of Mental Health (K01MH117222).

CONFLICT OF INTEREST DISCLOSURES

The author has no conflict of interest to report. This is an original report that has not previously been published in part or in full elsewhere. A pre-print version of this article has been posted to PsyArXiv (https://psyarxiv.com/xsey9/).

SUPPLEMENTAL MATERIAL

Supplemental material linked to the online version of the paper at journacswb.ca:

• ■ Supplemental Methods

• ■ Supplemental Results

AUTHOR AFFILIATIONS

^*Center for Healthy Minds, University of Wisconsin-Madison, USA..

REFERENCES

Azjen, I., Fishbein, M. (1980). Understanding attitudes and predicting social behavior. Prentice-Hall.

Britt, T. W., Cox, A. (2008). Perceived stigma and barriers to care for psychological treatment: Implications for reactions to stressors in different contexts. Journal of Social and Clinical Psychology, 27(4), 317–335. https://doi.org/10.1521/jscp.2008.27.4.317
Crossref  

Carleton, R. N., Afifi, T. O., Turner, S., Taillieu, T., Duranceau, S., LeBouthillier, D. M., Sareen, J., Ricciardelli, R., MacPhee, R. S., Groll, D., Hozempa, K., Brunet, A., Weekes, J. R., Griffiths, C. T., Abrams, K. J., Jones, N. A., Beshai, S., Cramm, H. A., Dobson, K. S., … Asmundson, G. J. G. (2017). Mental disorder symptoms among public safety personnel in Canada. The Canadian Journal of Psychiatry, 070674371772382. https://doi.org/10.1177/0706743717723825

Carleton, R. N., Afifi, T. O., Turner, S., Taillieu, T., Vaughan, A. D., Anderson, G. S., Ricciardelli, R., MacPhee, R. S., Cramm, H. A., Czarnuch, S., Hozempa, K., Camp, R. D. (2020). Mental health training, attitudes toward support, and screening positive for mental disorders. Cognitive Behaviour Therapy, 49(1), 55–73. https://doi.org/10.1080/16506073.2019.1575900
Crossref  

Cash, T. F., Begley, P. J., McCown, D. A., Weise, B. C. (1975). When counselors are heard but not seen: Initial impact of physical attractiveness. Journal of Counseling Psychology, 22(4), 273–279. https://doi.org/10.1037/H0076730
Crossref  

Christopher, M. S., Hunsinger, M., Goerling, L. R. J., Bowen, S., Rogers, B. S., Gross, C. R., Dapolonia, E., Pruessner, J. C. (2018). Mindfulness-based resilience training to reduce health risk, stress reactivity, and aggression among law enforcement officers: A feasibility and preliminary efficacy trial. Psychiatry Research, 264, 104–115. https://doi.org/10.1016/j.psychres.2018.03.059
Crossref  PubMed  

Cohen, S., Williamson, G. (1988). Perceived stress in a probability sample of the United States. The Social Psychology of Health, 13, 31–67. https://doi.org/10.1111/j.1559-1816.1983.tb02325.x

Drew, J. M., Martin, S. (2021). A national study of police mental health in the USA: Stigma, mental health and help-seeking behaviors. Journal of Police and Criminal Psychology, 36(2), 295–306. https://doi.org/10.1007/s11896-020-09424-9
Crossref  

Goff, P. A., Rau, H. (2020). Predicting bad policing: Theorizing burdensome and racially disparate policing through the lenses of social psychology and routine activities. Annals of the American Association of Political and Social Sciences, 687, 67–88. https://doi.org/10.1177/0002716220901349
Crossref  

Grupe, D. W., Smith, C., McGehee, C. (2021). Introducing mindfulness training and research into policing: Strategies for successful implementation. In E. Arble B. B. Arnetz (Eds.), Interventions, Training, and Technologies for Improved Police Well-Being and Performance (pp. 125–149). IGI Global.
Crossref  

Grupe, D. W., Stoller, J. L., Alonso, C., McGehee, C., Smith, C., Mumford, J. A., Rosenkranz, M. A., Davidson, R. J. (2021). The impact of mindfulness training on police officer stress, mental health, and salivary cortisol levels. Frontiers in Psychology, 12, 720753. https://doi.org/10.3389/fpsyg.2021.720753
Crossref  PubMed  

Hammer, J. H., Parent, M. C., Spiker, D. A. (2018). Mental help seeking attitudes scale (MHSAS): Development, reliability, validity, and comparison with the ATSPPH-SF and IASMHS-PO. Journal of Counseling Psychology, 65(1), 74–85. https://doi.org/10.1037/cou0000248
Crossref  PubMed  

Hays, R. D., Spritzer, K. L., Schalet, B. D., Cella, D. (2018). PROMIS®-29 v2.0 profile physical and mental health summary scores. Quality of Life Research, 27(7), 1885–1891. https://doi.org/10.1007/s11136-018-1842-3
Crossref  PubMed  

Karaffa, K. M., Koch, J. M. (2016). Stigma, pluralistic ignorance, and attitudes toward seeking mental health services among police officers. Criminal Justice and Behavior, 43(6), 759–777. https://doi.org/10.1177/0093854815613103
Crossref  

Karaffa, K. M., Tochkov, K. (2013). Attitudes toward seeking mental health treatment among law enforcement officers. Applied Psychology in Criminal Justice, 9(2), 75–99.

Lentz, L., Silverstone, P. H., Krameddine, Y. I. (2020). High rates of mental health disorders in civilian employees working in police organizations. Frontiers in Psychology, 11, 1031. https://doi.org/10.3389/fpsyg.2020.01031.
Crossref  PubMed  

Li, W., Dorstyn, D. S., Denson, L. A. (2014). Psychosocial correlates of college students’ help-seeking intention: A meta-analysis. Professional Psychology: Research and Practice, 45(3), 163–170. https://doi.org/10.1037/a0037118
Crossref  

Lin, J. (2021). Introduction to Structural Equation Modeling (SEM) in R. Retrieved from: https://stats.idre.ucla.edu/r/seminars/rsem/

Ma, D. S., Correll, J., Wittenbrink, B., Bar-Anan, Y., Sriram, N., Nosek, B. A. (2013). When fatigue turns deadly: The association between fatigue and racial bias in the decision to shoot. Basic and Applied Social Psychology, 35(6), 515–524. https://doi.org/10.1080/01973533.2013.840630
Crossref  

Marin, A. (2012). In the line of duty: Investigation into how the Ontario provincial police and the Ministry of Community Safety and Correctional Services have addressed operational stress injuries affecting police officers. Ombudsman Ontario, Toronto.

McCarty, W. P., Skogan, W. G. (2013). Job-related burnout among civilian and sworn police personnel. Police Quarterly, 16(1), 66–84. https://doi.org/10.1177/1098611112457357
Crossref  

Menakem, R. (2017). My grandmother’s hands: Racialized trauma and the pathway to mending our hearts and bodies. Central Recovery Press.

Newell, C. J., Ricciardelli, R., Czarnuch, S. M., Martin, K. (2022). Police staff and mental health: Barriers and recommendations for improving help-seeking. Police Practice and Research, 23(1), 111–124. https://doi.org/10.1080/15614263.2021.1979398
Crossref  

Pasciak, A. R., Kelley, T. M. (2013). Conformity to traditional gender norms by male police officers exposed to trauma: Implications for critical incident stress debriefing. Applied Psychology in Criminal Justice, 9(2), 137–156.

R Core Team. (2020). R: A Language and Environment for Statistical Computing. Retrieved from: https://www.r-project.org/

Rajaratnam, S. M. W., Barger, L. K., Lockley, S. W., Shea, S. A., Wang, W., Landrigan, C. P., O’Brien, C. S., Qadri, S., Sullivan, J. P., Cade, B. E., Epstein, L. J., White, D. P., Czeisler, C. A. (2011). Sleep disorders, health, and safety in police officers. JAMA, 306(23), 2567–2578. https://doi.org/10.1001/jama.2011.1851
Crossref  PubMed  

Rees, B., Smith, J. (2008). Breaking the silence: The traumatic circle of policing. International Journal of Police Science Management, 10(3), 267–279. https://doi.org/10.1350/ijps.2008.10.3.83

Ricciardelli, R., Carleton, R. N., Mooney, T., Cramm, H. (2020). “Playing the system”: Structural factors potentiating mental health stigma, challenging awareness, and creating barriers to care for Canadian public safety personnel. Health: An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine, 24(3), 259–278. https://doi.org/10.1177/1363459318800167
Crossref  

Rosseel, Y. (2011). lavaan: An R package for structural equation modeling. Journal of Statistical Software, 48. https://doi.org/10.18637/jss.v048.i02

RStudio Team. (2020). RStudio: Integrated Development Environment for R. Retrieved from: http://www.rstudio.com/

Spence, D. L., Fox, M., Moore, G. C., Estill, S., Comrie, N. E. (2019). Law Enforcement Mental Health and Wellness Act: Report to Congress. Retrieved from: https://cops.usdoj.gov/ric/Publications/cops-p370-pub.pdf

Syed, S., Ashwick, R., Schlosser, M., Jones, R., Rowe, S., Billings, J. (2020). Global prevalence and risk factors for mental health problems in police personnel: A systematic review and meta-analysis. Occupational and Environmental Medicine, 77(11), 737–747. https://doi.org/10.1136/oemed-2020-106498
Crossref  PubMed  

Thornicroft, G., Mehta, N., Clement, S., Evans-Lacko, S., Doherty, M., Rose, D., Koschorke, M., Shidhaye, R., O’Reilly, C., Henderson, C. (2016). Evidence for effective interventions to reduce mental-health-related stigma and discrimination. The Lancet, 387(10023), 1123–1132. https://doi.org/10.1016/S0140-6736(15)00298-6
Crossref  

Tuckey, M. R., Winwood, P. C., Dollard, M. F. (2012). Psychosocial culture and pathways to psychological injury within policing. Police Practice and Research, 13(3), 224–240. https://doi.org/10.1080/15614263.2011.574072
Crossref  

Vogel, D. L., Wade, N. G., Haake, S. (2006). Measuring the self-stigma associated with seeking psychological help. Journal of Counseling Psychology, 53(3), 325–337. https://doi.org/10.1037/0022-0167.53.3.325
Crossref  

Vogel, D. L., Wade, N. G., Hackler, A. H. (2007). Perceived public stigma and the willingness to seek counseling: The mediating roles of self-stigma and attitudes toward counseling. Journal of Counseling Psychology, 54(1), 40–50. https://doi.org/10.1037/0022-0167.54.1.40
Crossref  

Wester, S. R., Arndt, D., Sedivy, S. K., Arndt, L. (2010). Male police officers and stigma associated with counseling: The role of anticipated risks, anticipated benefits and gender role conflict. Psychology of Men Masculinity, 11(4), 286–302. https://doi.org/10.1037/a0019108
Crossref  

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Journal of CSWB, VOLUME 8, NUMBER Suppl 1, February 2023