Sleep quality and associated factors among police officers in Northwest Ethiopia: a cross-sectional study

Abstract

Background

Police officers are particularly vulnerable to poor sleep quality, which can have a serious detrimental impact on their health because of the numerous stressors they deal with on a daily basis. Therefore, police officers who suffer from sleep problems and do not receive proper diagnosis and treatment may perform less well at work, which could endanger both their own safety and the protection of the community they serve. The purpose of this study was to evaluate the prevalence of poor sleep quality and its associated factors among police officers in Bahirdar city, Northwest Ethiopia.

Methods

An institutional-based cross-sectional study was conducted among police officers in Bahirdar City. A total of 422 police officers were selected by a simple random sampling method. Sleep quality was assessed by using the Pittsburgh Sleep Quality Index. The associated factors were measured using multivariable logistic regressions. Odds ratios, 95% CIs, and p-values less than 0.05 were used to characterize the relationships between the variables.

Result

The prevalence of poor sleep quality was 42.9% (95% CI; 38.2, 46.7). Odds of being female (AOR: 4.85, 95% CI; 2.46, 9.53), single (AOR:4.55, 95% CI; 2.36, 8.78), having poor social support (AOR: 5.28, 95% CI; 2.93, 9.51), having depressive symptoms (AOR:4.40, 95% CI; 2.30, 8.41), experiencing Post-Traumatic Stress Disorder (AOR: 4.63, 95% CI; 1.88, 11.39), having moderate stress (AOR: 2.66, 95% CI; 1.42, 4.37), and severe stress (AOR: 5.32, 95% CI; 2.45, 9.13) were significantly associated with poor sleep quality.

Conclusions

Poor sleep quality was found to be highly prevalent among police officers in Bahir Dar city. Approximately 43% of the police officers reported having trouble sleeping. These results suggest that the need for targeted intervention to cope with sleep disturbance is necessary; police officers require proper psychosocial intervention programs and sleep health promotion, focusing specifically on female officers, single officers, those with low social support networks, and those exhibiting symptoms of depression and post-traumatic stress disorder.

Background

Since sleep is essential to human life and affects many aspects of human physiology, getting enough sleep is crucial for preserving overall health and wellness (Simonelli et al. 2018). A person’s satisfaction with their sleep experience is referred to as their sleep quality, and it takes into account various aspects like waking, sleep quantity, maintenance, and commencement (Buysse et al. 1989).

As a growing public health concern, poor sleep quality is particularly common among police officers (Khan et al. 2018). Worldwide, 20–30% of adults struggle to fall asleep (Sandlund et al. 2016). According to a 2019 systematic review and meta-analysis of police officers’ sleep quality, 51% of them reported having poor sleep (Garbarino et al. 2019). Research from several sources revealed that 54% of New York police officers (Fekedulegn et al. 2016), 50.8% of Thai police officers (Romyen and Kanchanakhan 2019), 52.3% of Taiwanese police officers (Chang et al. 2015), 63.6% of Brazilian police officers (Pinto et al. 2018), and 69% of Australian police officers (Elliott and Lal 2016) reported having poor sleep quality.

Sleep quality determines physical, mental, and workplace well-being. Among policemen, however, sleep quality has increasingly become a problem, and that’s because of their work features, including irregular hours, high levels of stress, and exposure to traumatic events (Garbarino et al. 2002). Sleep disturbance has many negative repercussions but mainly increased risk for many cardiovascular diseases, decline in cognitive function, decreased performance at jobs, extended work schedules, traumatic events, and job dissatisfaction brought on by unfavorable interpersonal interactions with supervisors and/or coworkers (Charles et al. 2011; Ma 2011; Åkerstedt et al. 2007). This risk is significantly increased due to the critical nature of duties because they, on one hand, need to make really good decisions, and on the other hand, the timing of those decisions becomes critical for public safety (Rajaratnam et al. 2011).

A lack of quality sleep is associated with daytime functional deficiencies that lead to reduced health-related quality of life, serious health conditions like diabetes, cardiovascular disease, depression, and PTSD, as well as absenteeism, lost productivity, cognitive performance, and workplace safety (Fekedulegn et al. 2016; Cappuccio and Miller 2017; Wang et al. 2020). If untreated, these deficiencies can even become life-threatening (Astill et al. 2012). A growing number of occupations, particularly those involving police and first responders, now require shift work due to the clear need for 24-hour coverage, thus shift workers deal with numerous stressors that can impair their quality of sleep (Fekedulegn et al. 2016).

Burnout symptoms are linked to sleep, as those who experience burnout often report fragmented sleep, low subjective sleep quality, and non-restorative sleep, thus become detached from their work and therefore confront their problems less (Wassermann et al. 2019). Because missions are always the top priority and there is seldom a time to evaluate sleep disturbance, sleep problems and their detrimental effects on police personnel are frequently overlooked (Waters and Ussery 2007). Factors such as alcohol drinking, khat consumption, cigarette smoking, extensive work schedules, shift work, occupational stress, and dangerous and traumatic occurrences, depression, and PTSD are all risk factors for police officers and are associated with poor sleep quality (Garcia 2023; Pradhan 2021; Allison et al. 2020).

Police officers who experienced poor sleep quality did not typically contact healthcare practitioners, despite the fact that sleeping issues are highly prevalent and that effective treatments are available. Lack of knowledge about available treatments and self-medication with alcohol or over-the-counter medications are potential obstacles to getting help. Despite the fact that the severity of this public health concern is anticipated to be greater in low- and middle-income nations, particularly in Africa, even though there is well-demonstrated evidence pointing to the bad effects of poor sleep quality, studies in sleep among police officers in Ethiopia are still very rare (Âkerstedt 2006). It has been uncovered that in law enforcement, sleep deprivation can lead to the lowering of cognitive functions, which in turn increases the risk of getting sick with chronic disease and even stress-related ailments. In addition, poor quality of sleep among police officers not only affects their personal well-being but also compromises public safety and the effectiveness of law enforcement services (Rajaratnam et al. 2011). This gap can be because people do not recognize that sleep is a public health priority, and they are focused on other threats such as physical injuries and mental stress. The purpose of this study was to ascertain the prevalence of poor sleep quality and its associated factors among police officers of Bahir Dar city, Northwest Ethiopia. Its objectives are to identify novel predictors and to inform contextually relevant interventions for enhancing sleep quality and lessening negative impacts on health and job performance. This research will, therefore, make valuable contributions to the body of knowledge on occupational health issues internationally and act as a propellant for further research and policy initiatives in such contexts by focusing on a population mostly ignored in sleep studies.

Methods

Study area and period

From March 10 to April 8, 2021, the study was carried out at Bahirdar City, which is the Amhara Regional State capital. Sub-cities make up six of it. The anticipated number of houses and the total population of the city are 69,424 and 312,410, respectively, according to a 2019 municipal administration report. Of these, 145,579 are men and 166,831 are women. Bahir Dar is situated at the Abbay’s entrance from Lake Tana, at 1,820 m (5,970 feet) above sea level. The city is roughly 565 km northwest of Addis Ababa. According to the Bahir Dar City Administration police department, there are 7 police stations and 1134 police officers in the city.

Study design

Institutional based cross-sectional study was conducted.

Population

All police officers in Bahir Dar city were considered the source population, and selected police officers in Bahir Dar city during the study period were the study population.

Eligibility criteria

Police officers who were present at the time of data collection were included in the study, while those who were newly enrolled, officers who worked less than one month, and police officers who left the workplace for obligation were excluded.

Sample size determination

In this study, the sample size was determined by using a single population proportion formula based on the estimated prevalence rate of sleep quality at 50% since there is no previous available study conducted on the police population in Ethiopia. With a 95% confidence level and a 5% margin of error applying the formula and a 10% non-response rate, the sample size was 422.

Sampling procedure

Of the seven police stations, this includes 1134 police officers. A simple random sampling technique was used to select study units by utilizing the sampling frame, which was obtained from the city police departments, and after identifying initial starting police officers by the lottery method.

Data collection tools and procedures

Four data collectors and one supervisor were recruited. Data was collected by trained data collectors by using the Amharic version of self-administered questionnaires. The questionnaire was first prepared in English, then translated to Amharic, and then translated back to English by an independent person to check for consistency and understandability of the tool.

A pre-test was conducted with 21 respondents in Merawi Town, outside the study area, for clarity of questionnaires, 1 week prior to actual data collection. Regular supervision by the supervisors and the principal investigator was made to ensure that all necessary data were properly collected. The collected data was cleaned and checked for completeness before being processed and entered from paper into a computer.

Data was gathered by PSQI and a self-administered, structured questionnaire. Seven clinically significant categories of sleep difficulties—I, subjective sleep quality; II, sleep latency; III, length; IV, efficiency; V, sleep disruptions; VI, use of sleep medicine; and VII, daytime dysfunction—are included in the PSQI, which has 19 items total (Buysse et al. 2008). When assessing individuals who live in communities, the tool has been validated in Ethiopia’s South West region for sleep issues. Cronbach’s alpha for the tool is 0.59 (Salahuddin et al. 2017), indicating internal consistency. When the individual values for each of these aspects are added together, a global score of overall sleep quality can be determined that ranges from 0 to 21 (Buysse et al. 1989). We selected the Pittsburgh Sleep Quality Index because it measures the prevalence of sleep over the previous month (Mollayeva et al. 2016). Poor sleep quality was determined by screening with the Pittsburgh Sleep Quality Index (PSQI) at a cut-off point higher than 5.5. Good sleep quality was defined as a score on this scale that was less than or equal to 5.5 (Mollayeva et al. 2016).

Post-traumatic stress disorder was collected using the standard PTSD Checklist—Civilian Version (PCL-C) questionnaire. It has a total of 17 items and measures the type and frequency of PTSD symptoms. The PCL scales have 5-point Likert scales ranging from 1 (not at all) to 5 (extremely). The cut-off point was set at greater than or equal to 50; responders who scored less than 50 had no PTSD, and those who scored 50 had PTSD (Bezabh et al. 2018).

Occupational stress was measured by using the Organizational Police Stress Questionnaire (PSQ-ORG). It has a seven-point Likert scale ranging from “not at all stressful,” “moderately stressful,” and “very stressful. The PSQ-OP showed good internal consistency (Cronbach’s α = 0.89). According to organizational police stress scale values, below 2.0 indicates low stress, between 2.1 and 3.4 indicates moderate stress, and above 3.5 indicates severe stress (Queirós et al. 2020).

Social support: according to the Oslo-3 Social Support Scale, a score of 3–8 is taken as poor support, 9–11 as moderate support, and 12–14 as strong support (Abiola et al. 2013). Depression: according to the PHQ-9, scoring ≥ 10 was screened as having depression symptoms (Manea et al. 2012). Current substance use: Those who used substances within the last 3 months (Group 2002). A socio-demographic questionnaire was used to assess the patients’ background information, and all the questionnaires were operationalized according to the tools.

Data processing and analysis

Data was checked for completeness, and then it was coded, entered into Epi-data version 3.1, and exported to SPSS version 25. The association between dependent and independent variables was assessed, and its strength was presented using adjusted odds ratios and 95% confidence intervals. Data was presented by using frequency tables, charts, and figures.

Bivariable and multivariable logistic regression analyses were carried out. Variables with a p-value of 0.25 were taken to multivariable analysis, and a p-value less than 0.05 was judged to be associated with poor sleep quality. To evaluate the presence of multicollinearity among independent variables, Variance Inflation Factor was computed, and the results of the assumption of multicollinearity, including average VIF and individual VIF values, can be found in Supplementary Material Table 1. The Hosmer-Lemeshow test as well as the Pearson chi-square were also performed to evaluate the goodness-of-fit of the regression model; results of this testing are included in Supplementary Material Table 2.

Results

Socio-demographic characteristics of the respondents

A total of 401 respondents participated, with a response rate of 95.02%. The mean age of participants was 28.45 years with a standard deviation of ± 5.41 years, and most respondents, 317 (79.05%), were males. The majority of the respondents, 149 (37.2%), were between the ages of 21 and 25 years old, Orthodox Christian by religion, 352 (87.8%), single, 232 (57.9%), attended college diploma/above, 241 (60.1%), and lived alone, 224 (55.9%) (Table 1).

Table 1 Socio-demographic characteristics of police officers in Bahir Dar City, northwest Ethiopia, 2021. (n = 401)

Sleep quality and its component scores

Overall, the prevalence of poor sleep quality in this study population was 42.9% (95% CI: 38.2–46.7). Whereas those who have good sleep quality were found to be 57.1%. In the assessment of subjective or self-reported poor sleep quality, 25 (6.2%) and 8 (2%) of the respondents reported that their sleep quality was fairly bad and very bad, respectively. Self-reports of daytime dysfunction were 50% who reported daytime dysfunction less than once a week and 19% who reported daytime dysfunction three or more times a week. The majority of participants (65.8%) scored the habitual sleep efficiency of greater or equal to 85%. Use of sleep medication three more times a week was (1.7%) in the last month (Table 2).

Table 2 Pittsburgh sleep quality index (PSQI), subscales of police officers, Bahir Dar Ethiopia, 2021. (n = 401)

Clinical and psychosocial factors

A total of 118 (29.4%) participants have depression, and 60 (15%) of the respondents have posttraumatic stress symptoms. Concerning the occupational stress, 107 (26.7%) of the study participants have moderate occupational stress, and 61 (15.2%) reported severe occupational stress. Nearly one-third (39.9%) of the participants have low social support. Of 40 (10%) have a known chronic medical condition that has been diagnosed. Around 47 (11.7%) of individuals report smoking cigarettes currently, 221 (55.1%) have drunk alcohol currently, and 44 (11%) also reported current khat chewing (Table 3).

Table 3 Clinical and psychosocial factors of the respondents of police officers in Bahir Dar city, northwest Ethiopia, 2021. (n = 401)

Factors associated with poor sleep quality

The prevalence of poor sleep quality in these participants was 42.9% (95% CI: 38.2–46.7). In the multivariable analysis, being female (AOR: 4.85, 95% CI; 2.46, 9.53), single (AOR:4.55, 95% CI; 2.36, 8.78), having poor social support (AOR: 5.28, 95% CI; 2.93, 9.51), having depressive symptoms (AOR:4.40, 95% CI; 2.30, 8.41), experiencing Post-Traumatic Stress Disorder (AOR: 4.63, 95% CI; 1.88, 11.39), having moderate stress (AOR: 2.66, 95% CI; 1.42, 4.37), and severe stress (AOR: 5.32, 95% CI; 2.45, 9.13) were significantly associated with poor sleep quality (Table 4).

Table 4 Bivariable and multivariable independent factors of poor sleep quality among police officers in Bahir Dar city, northwest Ethiopia, 2021 (n = 401)

Discussion

Police officers who get poor-quality sleep may experience detrimental effects on their health and the safety of their families. The fact that police officers suffer from poor sleep quality at a very high rate points to occupational and environmental factors as the main causes for sleep interruptions like shift work, stress, and lack of resources for health promotion. According to this study, 42.9% of Bahir Dar City police officers had poor sleep quality. This result was consistent with recent findings that found poor sleep quality was experienced by 40.9% of Chinese military personnel(Wang et al. 2020), 39% of U.S. law enforcement officers (Everding et al. 2016), and 40.4% of North American police officers (Rajaratnam et al. 2011).

The results of our study are lower than those of earlier research, which indicated that 50.8% of Thai police officers had poor sleep quality (Romyen and Kanchanakhan 2019). One explanation for the variation may be a long workday and a delayed shift schedule; another may be the highly stressful nature of their jobs and numerous working conditions (the northern region of Thailand has the highest rate of police suicides), which could reduce sleep quality, as various studies have confirmed (Gershon et al. 2002), and a Brazilian police officer’s suicide rate was 63.6% (Pinto et al. 2018). In addition to work-related events (such as officers reporting traumas, gunshot wounds, auto accidents, and traumatic amputations), thus quality of sleep decreases after a work-related injury (Neylan et al. 2002), and this group may also have co-occurring sleep disorders, such as obstructive sleep apnea syndrome (Pinto et al. 2018), which may increase the prevalence of poor sleep quality.

In addition, our study’s findings are less than those of previous studies that found 69% of Australian police officers from the New South Wales Police Force reported having poor sleep quality (Elliott and Lal 2016). The differences in the tools used for evaluating those occupational-related problems and demographic factors are among the main reasons for the discrepancies noticed. It is common for studies in Australia to use tools such as the Epworth Sleepiness Scale (ESS), which measures daytime sleepiness, or the Pittsburgh Sleep Quality Index (PSQI), which assesses all the sleeping problems together (Rajaratnam et al. 2011). Additionally, Australian police officers might be confronted with diverse work issues, such as night shifts that are very often, stress from policing in the city, and a sitting lifestyle, which can lead to increased obesity, high blood pressure, and other chronic diseases issues that are well-known causes of poor sleep quality (Garbarino et al. 2002).

Furthermore, our study’s findings are less than that of a study conducted on New York City’s urban police officers, which revealed a 54% prevalence of poor sleep quality (Fekedulegn et al. 2016). Three shift work categories (day, afternoon, and night), a larger sample size, and a five-year extension of the study’s recorded follow-up history could account for the discrepancy. Among Taiwanese police officers, 52.3% reported having poor-quality sleep(Chang et al. 2015). Given that they utilized the 19-item Chinese version of the PSQI, with a cut point of more than 5, the discrepancies may have been due to tool variations. Additionally, only men make up the sociodemographic variance between the study participants and the community, and they both had concomitant metabolic syndrome.

On the other hand, our result was higher than the other studies, including 35.7% of shift workers and 26.3% of non-shift workers in the study of Italian police officers who have poor sleep quality (Garbarino et al. 2002). This might be due to the fact that they were all working on fast-rotating shift schedules, and the non-shift workers mostly performed office tasks. When there were fast-rotting and flexible shifts, there would have been better and improving sleep; a study revealed this (Eriksen and Kecklund 2007), and 32.1% of the general population of Austrians reported poor sleep quality (Zeitlhofer et al. 2000). This discrepancy might be due to the difference in study population; the Australian study was done on the general population, whereas our study was conducted on police officers. Reported variations between different studies may be due to different socioeconomic status and cultural backgrounds among the current and previous studies. The other reason could be differences in geographical area, characteristics of participants, or variation in service delivery.

In this study, women were 4.85 times more likely than men to have poor sleep quality. This is in line with earlier research on the quality of sleep recorded by New York police officers (Charles et al. 2011). One possible explanation is that women working in law enforcement may experience higher levels of stress due to exposure to extra stresses and sexually offensive actions, which can lead to poor sleep quality (Charles et al. 2011). Men are not typically exposed to these kinds of situations. Another factor for poor sleep quality could be the way our culture treats women differently in terms of their economic, political, and social status (Chang et al. 2015). Because of the weight of domestic obligations and an overwhelming workload, women experience stress at higher rates than men.

Compared to respondents who were married, individuals who were single (unmarried) had a 4.55-fold higher risk of experiencing poor sleep quality. This is in line with the findings of earlier research (Arthur 2016). The respondents’ single status may have contributed to their mental health issues, such as anxiety and depression, which in turn may have lowered their quality of sleep (August 2022). When comparing respondents with intermediate social support to those with low social support, the risks of getting poor sleep quality were 5.28 times higher. This may be because interpersonal pressures might intensify social-affective processes, which in turn lead to poorer sleep quality, and because there are unpleasant ties associated with lower sleep quality (Kent et al. 2015).

Poor sleep quality was 4.63 times more common among those who had experienced PTSD symptoms than among those who had not. Previous research on the quality of sleep among US police personnel provides support for this (Neylan et al. 2002). One explanation for this could be A fundamental clinical characteristic of post-traumatic stress disorder (PTSD) is sleep disturbances, which can aggravate the illness’s course. Severe PTSD symptoms are correlated with increased overall sleep disturbances severity, and psychiatric comorbidity is probably linked to more severe complaints of poor sleep quality (Germain et al. 2004).

When compared to responders without occupational stress, those with severe occupational stress had 5.32 times higher odds of developing poor sleep quality. This study is in line with research on Jamaican and Swiss police personnel, respectively (Gerber et al. 2010; Nelson and Smith 2016). Role conflicts linked to poor sleep quality and other work-related issues like workload may help to explain this. Similarly, occupational stress has been linked to a number of aspects of poor sleep quality, including daytime dysfunction, duration of sleep, disruptions in sleep, and the use of sleeping pills (Nelson and Smith 2016; Mao et al. 2023). Another possible cause of poor sleep quality is work-related stress, as evidenced by the correlation between poorer levels of supportive and positive work environments and higher rates of sleep disturbances.

The likelihood of having poor sleep quality was 4.4 times higher among those who had experienced depressive symptoms than in those who had not. A research study on police officers’ sleep quality conducted in the US provides evidence for this (Neylan et al. 2002). This could be the result of depression or sleep disturbance, both of which are mental disorders. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (Edition 2013) of the American Psychiatric Association lists the symptoms of various sleep disturbances in conjunction with depression.

Police officers’ sleep quality is important and substantial overall, and if their sleep disorders are not properly recognized and treated, they may have performance issues at work and eventually jeopardize their personal safety as well as the safety of the community they serve.

Limitation of the study

Self-reported sleep quality is used in the study, however subjectivity and a number of complicating factors could make it erroneous. Police officers may be reluctant to participate in research that involve extensive tracking of their sleep patterns due to privacy concerns and possible employment consequences. Social desirability bias may also result from participants’ propensity to provide socially acceptable answers to sensitive queries regarding substance usage. Furthermore, because there hasn’t been any prior research on Ethiopian police officers’ sleep quality, it is difficult to compare our study with others.

Conclusions

Poor sleep quality was found to be highly prevalent among police officers in Bahir Dar city. Approximately 43% of the police officers reported having trouble sleeping. These results suggest that the need for targeted intervention to cope with sleep disturbance is necessary; police officers require proper psychosocial intervention programs and sleep health promotion, focusing specifically on female officers, single officers, those with low social support networks, and those exhibiting symptoms of depression and post-traumatic stress disorder.