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Background: The prevalence of PTSD in police officers has been the subject of a large and highly variable empirical literature. The present systematic review evaluates the extant literature on PTSD in police officers using an international dataset. Methods:We employed best-evidence narrative synthesis to evaluate whether PTSD prevalence in police is elevated in comparison to the general population of Canada (8%), which itself has a higher lifetime PTSD prevalence than many other regions and thus serves as a conservative standard of comparison.Results: PTSD prevalence in police varied considerably across studies from 0% -44% (M = 14.87%, Median = 9.2%). Despite this variability, strong evidence exists to suggest PTSD prevalence is elevated in police officers. Examination of possible sources of variability in prevalence outcomes highlighted substantial variability in outcomes due to the selection of measurement tool for assessing PTSD (e.g., DSM vs. IES). Examination of commonly-assessed predictive factors for PTSD risk across the literature showed that individual-difference factors (e.g., age, years of service) bear weak-to-nonexistent relationships with PTSD risk, while incidentspecific factors (e.g., severity of exposure) are more strongly and consistently associated with PTSD prevalence. Organizational factors (e.g., low support from supervisor) are at present understudied but important possible contributors to PTSD risk. Conclusions: PTSD prevalence is elevated in police officers and appears most strongly related to workplace exposure. Measurement variability remains a critical source of inconsistencies across the literature with drastic implications for accurate detection of officers in need of mental health intervention. K E Y W O R D S epidemiology, occupational exposure, police personnel, posttraumatic stress disorder, trauma Institution at which the work was performed: University of Northern British Columbia

Due to high rates of potentially traumatic exposure (PTE) within the firefighting profession, a large body of literature concerning firefighters' mental health has developed over recent decades. However, given variable prevalence outcomes and the largely descriptive nature of most studies, it is unclear whether the prevalence of trauma-related mental disorders in firefighters is elevated in comparison with the general population. The present systematic review examined literature on prevalence of posttraumatic stress disorder, depression, and anxiety in firefighters exposed to routine, duty-related PTEs to synthesize prevalence outcomes across the literature. Systematic search of 6 databases was conducted to review eligible articles published between 1980 and 2017 in any language. In all, 40 articles concerned firefighters exposed to routine work-related PTE. We report that strong evidence exists to suggest that the prevalence of posttraumatic stress disorder and depression is elevated in firefighters compared with the general population of Canada, whereas moderate evidence exists for the elevated prevalence of anxiety disorders. However, measurement tool is a substantial source of variability in prevalence estimates across the literature, and few predictive factors bear consistent relationships to posttraumatic stress disorder across samples. Future work should focus on measurement variance and examine possible interactions between commonly assessed predictive factors for disorder risk in firefighters.

Purpose The purpose of this systematic review is to evaluate the extant literature on depression and anxiety disorders in police using a multinational data set to determine whether the prevalence of these trauma-related disorders (TRMDs) is elevated in comparison to the general population. Design/methodology/approach Systematic review was employed in combination with best-evidence narrative synthesis to evaluate these hypotheses. Findings Despite wide variability in prevalence outcomes across the literature, strong evidence supports the hypothesis that the prevalence of depression is elevated in police, whereas moderate evidence supports the same hypothesis regarding anxiety. Preliminary evaluation of commonly examined predictive factors for each disorder demonstrated weak and inconsistent associations between these TRMDs and sociodemographic factors. No studies evaluated the relationship between incident-related factors (e.g. severity or frequency of exposure) and TRMDs, thus, at present, the literature on police is almost entirely unable to address the question of whether the prevalence of these disorders in police is influenced by exposure to work-related trauma. Research limitations/implications The findings highlight a critical need for future work to address incident-related factors in predicting symptoms of depression and anxiety in police samples to determine whether these disorders bear a unique relationship to work-related traumatic exposure. Such work will significantly benefit the design and implementation of successful prevention and intervention strategies in the workplace. Originality/value The present review provides a comprehensive synthesis of a highly variable literature, highlighting critical gaps in our current knowledge of TRMDs in police and suggesting numerous avenues for future study.

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