CHAPTER FOUR
RESULTS
In this systematic literature review, the psychological factors linked to the high prevalence of suicide among law enforcement officers in the United States and effective strategies for alleviating work-related stress were examined. The research objectives were to investigate the intricate interplay between law enforcement agencies and society, the existing mental health treatment initiatives accessible to police officers, the prevailing police subculture, and the obstacles impeding the use of such treatment options. The following questions helped guide this thorough qualitative literature review:
RQ1. What psychological factors most negatively impacted law enforcement officer well-being?
RQ2. What practices were in place to screen officers for mental health challenges and suicidal thoughts?
RQ3. What barriers to mental health treatment did law enforcement officers encounter?
RQ4. Based on the lived experience of law enforcement officers, what treatment approaches were most effective?
Participants 
The composition of participants in the evidence synthesis included both male and female law enforcement officers that were actively employed with a police agency in the United States. Most participants in this study were of the male gender, attributable to the disproportionate representation of males employed in the police force. The systematic review included studies that involved individuals from diverse ethnic backgrounds and across a range of age cohorts. The study included a heterogeneous group of persons, consisting of both novice cadets newly enrolled at the police academy, as well as seasoned professionals with extensive experience in the realm of law enforcement. The evidence synthesis spanned a wide geographical scope, incorporating numerous United States law enforcement agencies from various demographic regions including rural, urban, and suburban communities. The settings included in this evidence synthesis were broad and ranged from highly inhabited to sparsely populated, to rural locations across the United States.
Results Research Question One
The rate of suicide among public safety officers is higher in comparison to that of the U.S. general population. An extensive study was carried out utilizing data extracted from death certificates originating from 26 states within the United States. The study consisted of states in the West, Northeast, Midwest, and South. The findings suggest that police officers have a considerably higher rate of suicide-related mortality compared to the non-police officer study group. Specifically, police officers have a 54% higher likelihood of dying by suicide compared to individuals in other occupations (Violanti & Steege, 2021). There may be many job-related factors that contribute to poor mental health and suicidality in police officers. The career is related with several demands, including organizational, operational, physical, and administrative factors (Edwards et al., 2021; McCarty et al., 2019; Violanti, 2017). Police personnel have numerous other challenges that lead to their compromised mental well-being. Individuals in this population encounter a range of challenges, including substance use, divorce, feelings of despair, anxiety, ptsd, and burnout. To enhance comprehension regarding strategies intended for mitigating the prevalence of mental illness and suicide within the police force, it would be advantageous to acquire knowledge pertaining to the psychological elements that exert the most adverse influence on the overall well-being of police officers. RQ1 included the synthesis of 70 journal articles. 
Deterioration of Mental Well-being
The initial prominent theme identified in the analysis of 17 articles revealed a significant prevalence of stress and burnout among law enforcement personnel. The potential etiology of impaired mental well-being among law enforcement officers can be attributed to various factors, including the stressors inherent in their professional responsibilities, utilization of maladaptive coping mechanisms, inadequate equilibrium between work and personal life, familial discord, and the experience of burnout. In certain circumstances, police officers may experience heightened distress that could potentially lead to self-harm or suicidal ideation (Baker et al., 2023).
The job stress encountered by officers can certainly be attributed to multiple factors in the external work environment, including adverse contacts with community members and increased anxiety stemming from the nature of the job (Paoline & Gau, 2023). Stressors ranging from increased work demands to inadequate support significantly contribute to the stress experienced by police officers, impacting their mental and physical health and potentially leading to burnout (Queirós al., 2020; Raju et al., 2020). The findings of research conducted on three urban police agencies in Texas indicate that organizational stressors play a substantial role in the development of anger, low-mood, and burnout (Bishopp et al., 2019). McCarty et al. (2019) demonstrated that organizational stress is associated with emotional fatigue, which serves as an indicator of burnout. The prevalence of suboptimal mental well-being within the police force is often accompanied by the adoption of maladaptive coping mechanisms, inadequate equilibrium between work and personal life, familial discord, and the onset of burnout (Griffin & Sun, 2017). According to a study conducted by Allison et al., (2019),  a significant number of police officers were found to be experiencing feelings of hopelessness, depression, and stress. Research has demonstrated that stress and burnout contributed to many police officers ending their own lives (Violanti et al., 2018; Ramchand et al., 2018). There exists a correlation between the demands inherent in the police profession and many negative mental health outcomes, including but not limited to anxiety, depression, elevated stress levels, burnout, and instances of suicide (Grant et al., 2019; Violanti et al., 2018). Extensive scholarly investigations pertaining to burnout among police officers have revealed notable instances of exhaustion and depersonalization, alongside established associations between burnout and mental health concerns (McCarty et al., 2019; Talavera-Velasco et al., 2018). 
The psychological health of the police officers seemed to be compromised due to their limited leisure time outside of work. The most prominent operational stressors were shown to be associated with temporal factors, health-related factors, or a combination of both. The organizational stressors that induce the highest levels of stress are primarily related to job demands and impartiality in leadership, specifically pertaining to the disparate distribution of job duties and the perception of inconsistent application of rules among officers. Operational stresses predominantly include events that occur in the field, including but not limited to responding to calls for assistance and incidents involving law enforcement officers discharging their firearms. Organizational stresses involve factors that are within the realm of managerial flexibility and decision-making, including hours of work, equipment, and resources (Edwards et al., 2021). 
The police service is often linked to significant expenses resulting from absenteeism and staff turnover, which are attributed to the presence of stress and burnout. There exists a significant association between burnout and symptoms of post-traumatic stress disorder, which can be attributed to both direct and indirect pathways, primarily including the process of rumination over the traumatic events that have been encountered. The results suggest that police officers who are encountering burnout and engage in rumination on past traumatic experiences are at a heightened risk of developing post-traumatic stress disorder. Law enforcement personnel who are afflicted by burnout exhibit diminished levels of energy to effectively cope with distressing stimuli, rendering them more susceptible to developing post-traumatic stress disorder (Ogińska-Bulik & Juczyński, 2021).  
The Significance of Organizational Stressors
The analysis of 15 studies uncovered a second significant theme, which indicated that organizational stressors exerted a greater influence on the mental well-being of police officers compared to other types of stressors. The origins of emotional distress are comparable for both police officers and non-operational police personnel, thereby demonstrating that suffering does not solely arise from police operations (Kerswell et al. 2020). Police personnel view organizational stressors as overbearing, unwarranted, and inevitable. The factors encompassed in this category consist of insufficient assistance, excessive workloads, shiftwork, court mandated days, interpersonal disputes with other officers or superiors, limited resources, time constraints, and an excessively bureaucratic structure that penalizes and tenaciously supervises individuals. These factors have the potential to contribute to and/or worsen symptoms of anxiety and depression, burnout, post-traumatic stress disorder, and thoughts of suicide.
A substantial body of research suggests that the operational stressors formerly believed to have the most adverse effects on mental well-being are not the primary stressors in the context of a law enforcement career (Gershon et al., 2009; Shane 2010; Trinker et al., 2016).  Many police officers often find themselves overwhelmed by the organizational challenges posed by strenuous job schedules, bureaucratic processes, and constant policy modifications. nepotism, government systems and processes, and styles, are perceived to have a greater influence on the mental well-being of officers (Chopko et al., 2021; Phythian et al.,2021; Baker et al., 2020;). Government procedural requirements, the persistent need to validate one's worth to the organization, disparate application of regulations, and inadequate staffing levels are prominent sources of stress experienced by police officers (Chopko et al., 2021). The findings of a meta-analysis examining the relationship between stresses experienced by law enforcement personnel and their health outcomes revealed that frequent exposure to stressors within the organizational context was significantly linked to adverse physical and mental health (Goh et al., 2015). According to Edwards et al., 2021, the primary factor contributing to stress was the insufficiency of personnel. Other prominent stressors in the workplace include high workload, conflicts with colleagues and supervisors, limited resources, and a bureaucratic organizational structure characterized by strict management and punitive measures towards police personnel (Moreno et al., 2016). Numerous studies repeatedly demonstrate that elevated levels of organizational stress are causally linked to diminished career satisfaction, thereby leading to turnover and insufficient staffing (McCreary & Thompson, 2006; Nisar & Rasheed, 2020; Wolfe & Lawson, 2020). 
Police officers are individuals who work in a professional capacity and are regularly exposed to various situations that may involve encountering challenging circumstances. These situations often entail continued exposure to instances of distress, potential risks to their personal safety as well as that of their colleagues, the utilization of weapons, participation in emergency operations, and exposure to traumatic events, including instances of death (Violanti et al., 2017; Violanti et al., 2019; Purba & Demou 2019). When considering law enforcement, one typically contemplates the inherent risks associated with the role, including the apprehension and arrest of those deemed dangerous, exposure to perilous situations on roadways, engagement in armed conflicts with potentially lethal suspects, and involvement in high-speed pursuits. 
However, it is the less apparent stressors that have demonstrated great influence on the mental well-being of police officers. The stressors that may not be readily apparent to individuals who are not employed as police officers incorporate various organizational characteristics, such as long hours, inadequate resources, social support, culture, leadership, and bureaucracy. The presence of certain organizational elements may give rise to adverse consequences for individuals, such as the development of stigmatized perceptions while seeking support services, the experience of anxiety and depressive symptoms, the occurrence of burnout, the manifestation of post-traumatic stress disorder, and the emergence of suicide ideation, among other potential outcomes. 
Elevated Prevalence of PTSD
	The examination of 14 articles revealed an additional noteworthy theme, suggesting that the prevalence of post-traumatic stress disorder (PTSD) within the police profession exceeds that of the general population. The phenomenon of police stress and trauma is characterized by its intricate structure, often encompassing regular, long-term exposure to stressors inherent in the profession, as well as potentially traumatic events. Police officers frequently encounter potentially stressful situations and have elevated levels of stress.  Police officers frequently experience numerous situations that have the potential to result in the development of post-traumatic stress disorder. Post-traumatic stress disorder is characterized by a range of symptoms, including the reliving of traumatic events, avoidance of trauma-related stimuli, negative cognitive patterns, mood disturbances, as well as heightened arousal, which may show as aggression, sleep disturbances, recklessness, or self-destructive behaviors (American Psychiatric Association, 2013). 
The traumatic situations generally acknowledged entail observing a person enduring severe injuries, sustaining severe injuries oneself, encountering catastrophic events, suffering physical attack, witnessing a colleague in law enforcement sustaining injuries, witnessing the death of an individual, being subjected to threats using firearms, or being targeted with gunfire (Hartley et al., 2014; Papazoglou, & Tuttle, 2018; Regehr, 2019).  Jetelina et al. (2020) found that an astounding 68% of 434 police officers screened positive for symptoms of PTSD.  The rate of PTSD among the general population is 4.4% (Powell-Chandler, 2020). In another study, law enforcement officers were found to have elevated levels of depression, anxiety, posttraumatic stress disorder (PTSD), and suicide in comparison to the broader population (Dawson, 2019). In separate studies, law enforcement officers exhibit a higher prevalence of heart disease, post-traumatic stress disorder (PTSD), and suicide compared to the general population (Spence & Drake, 2021; Hartley et al., 2011). Similarly, Collazo (2020) found police officers to be at an elevated risk of getting post-traumatic stress disorder (PTSD), experiencing suicide thoughts, and engaging in substance use as compared to individuals in the general population (Martinaki et al., 2021), which has lead
In comparison to other cohorts, individuals employed in the field of law enforcement exhibit a heightened susceptibility to a diverse range of potentially traumatic incidents. Consequently, there has been a notable escalation in the contingent susceptibility to experiencing compassion fatigue, moral injury, and post-traumatic stress disorder (Papazoglou, 2019). The findings of one study revealed that around 1 of 4 police officers exhibited symptoms indicative of either partial or full posttraumatic stress disorder, resulting in significant impairment in their daily functioning (Chopko et al., 2021). The experience of encountering death emerged as the most significant predictor for the manifestation of symptoms related to post-traumatic stress disorder, including intrusive traumatic memories and avoidance behaviors. Individuals who have been exposed to death may exhibit signs of hyperarousal associated with post-traumatic stress disorder. The heightened exposure to traumatic experiences may lead to an increased state of hypervigilance among law enforcement officers during the execution of their professional responsibilities.
Discussion Research Question One
There are many factors that contribute to the stress level of law enforcement officers. As a result, the stress level among police officers is substantial. There are significant associations of stress and burnout among the law enforcement population. Burnout ensues because of workplace stress that has not been effectively addressed. The evidence suggests that police officers need to improve their ability to mitigate stress and reduce burnout. The stress that derives from performing operational tasks would be difficult to prevent given the nature of the dangerous profession. The mitigation of stress arising from the execution of operational activities within a hazardous profession is a challenging endeavor due to the fundamental nature of the occupation. The high rate of organizational stress suggests that overworking, a poor work-life balance, and supervisory leadership that is not conducive to a supportive environment significantly impacts police officer stress. Nevertheless, it may be possible to ease the organizational stress associated with the profession through modifications in work hours, working environment, scheduling, and management styles. 
The evidence synthesis shows that police personnel encounter a significantly elevated level of trauma exposure and have a greater prevalence of post-traumatic stress disorder (PTSD) compared to the general population. The emergence of posttraumatic reactions can be attributed to the accumulation of exposure to duty-related critical situations, occupational pressures, and an increased exposure to traumatic events in the workplace. The organizational culture within law enforcement further amplifies risk factors associated with the onset of post-traumatic stress disorder (PTSD).
The examination of elevated levels of post-traumatic stress disorder (PTSD), burnout, and organizational pressures among police personnel, employing the theory of constructed emotion, offers a distinctive vantage point from which to understand the emotional encounters and reactions inside the realm of law enforcement. This idea proposes that emotions are not inherent or automatic responses, but rather are actively formed by the brain, greatly impacted by individual experiences, social and cultural circumstances, and the surroundings. This conceptual framework has the potential to facilitate a comprehensive understanding of the complex interplay between the internal and external obstacles encountered by law enforcement personnel and their psychological well.
Post-traumatic stress disorder (PTSD) among police officers might be viewed as a consequence of how they develop emotional reactions to terrible incidents they experience while working. Emotional processing can be strongly influenced by exposure to violent episodes, life-threatening scenarios, and the aftermath of crimes. Through the lens of constructed emotion, these events influence the brain's anticipations regarding the world, resulting in increased alertness, fear, and anxiety, which are fundamental attributes of post-traumatic stress disorder (PTSD). According to this theoretical perspective, therapies that seek to modify these constructed emotional experiences, through the provision of novel frameworks for interpreting and responding to traumatic memories, have the potential to alleviate symptoms associated with post-traumatic stress disorder (PTSD).
Burnout among police officers, characterized by emotional exhaustion, depersonalization, and reduced personal accomplishment, can also be explored within this framework. The theory of constructed emotion highlights how the repetitive nature of exposure to high-stress incidents, coupled with organizational demands, conditions officers to construct emotions of frustration, powerlessness, and cynicism. Officers may develop a perception of burnout by consistently anticipating bad consequences in their work environment and seeing a lack of support. Modifying these preconceived notions and affective reactions, potentially by cultivating settings that affirm and bolster the difficulties faced by law enforcement personnel, has the potential to mitigate the prevalence of burnout.
Officers experience severe mental distress due to organizational pressures such as excessive bureaucracy, limited resources, unclear job requirements, and unsupportive management. According to the theory of constructed emotion, the brain's process of constructing emotions in reaction to stress is influenced by previous experiences and the perceived consequences of these stressors on the professional identity and safety of officers. Law enforcement personnel may employ emotional reactions, such as skepticism, cynicism, or apathy, as adaptive strategies to effectively manage the perceived difficulties within their professional setting. Strategies aimed at reorganizing these emotional constructs, such as implementing organizational modifications or establishing support systems that specifically target certain stressors, have the potential to mitigate their effects.
The theory of constructed emotion provides a powerful explanatory framework for understanding the heightened incidences of PTSD, burnout, and the effects of organizational stressors among police officers. It highlights the significance of previous experiences and the sociocultural context in influencing the emotional reactions of law enforcement officers towards their job, indicating the possibility of implementing interventions that can modify these factors. Strategies that provide novel viewpoints and adaptive strategies, enhance constructive interpersonal exchanges, and cultivate a nurturing organizational environment may play a crucial role in rebuilding more salubrious emotional environments for law enforcement personnel, thereby alleviating the inherent mental health difficulties associated with police work.
Results Research Question Two

Due to the accumulation of traumatic experiences and the high incidence of post-traumatic stress disorder (PTSD) and other related disorders, first responders are widely regarded as a suitable population for routine mental health screening. The promotion of screening is frequently advocated as a strategy to support the maintenance of a mentally sound work environment. Police agencies engage in screening procedures with the aim of identifying initial signs of mental disorders, thereby facilitating timely mental health services. Police departments conduct pre-employment testing to decrease the likelihood of recruiting individuals who may exhibit vulnerability to prospective mental health issues. With the presentation of problematic behaviors, it may be necessary for experienced law enforcement personnel to undergo a fitness for duty evaluation.  Notwithstanding the deployment of screening tools, a substantial prevalence of mental health concerns persists among police officers. RQ 2 included the analysis of 46 articles. 
Predicator of Job Performance
The main finding derived from the examination of 11 studies over the span of 2014-2022 is that the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) has the potential to function as a prognostic instrument for forthcoming occurrences of misconduct by police officers. According to Marshall et al. (2020a), the MMPI-2 scales have been developed with the purpose of evaluating a range of characteristics that have been discovered in research as potential indicators of mental illness and psychopathology. A research investigation was conducted to explore the association between MMPI-2 scores and the particular behaviors that resulted in the cessation of employment within a substantial group of recently enlisted persons in the domain of law enforcement. According to Loya et al. (2022), the results of the study revealed a significant association between certain scores on the MMPI-2 and behaviors that hindered the attainment of successful employment within the police force. A distinct investigation unveiled that police officers who have faced allegations of employing disproportionate force and/or displaying racist conduct demonstrate elevated K scores and diminished F scores when compared to their peers within the sampled police officer population (Borgagna, 2022). Further research provides evidence to support the claim that the MMPI-2 exhibits a notable level of precision in forecasting potential behavioral problems among law enforcement personnel, encompassing mental, ethical, and performance-related difficulties (Sellbom et al., 2007; Weiss et al., 2013). Marshall et al. (2020b) and Marshall et al. (2021) conducted two further studies that yielded results indicating the absence of a statistically significant association between MMPI-2 scores and mental health issues.
According to a study conducted by Kim et al. (2021b), the application of Machine Learning (ML) methods in conjunction with the MMPI-2 has demonstrated reliable and consistent outcomes in accurately classifying and predicting an individual's suicidal ideation and past suicide attempts. The existence of a tool that demonstrates a high level of precision in projecting mental health results is beneficial. However, exercising caution throughout the selection procedure may present notable hazards, especially regarding the progression of cadets to following stages of the recruitment process. A further investigation that centers on the development of an innovative scale inside the MMPI-2 framework. The main purpose of this scale is to identify potential suicide risk in patients receiving assessment, namely those who may display reluctance in expressing clear suicidal thoughts or acts. According to Nichols et al. (2021), the results of this study indicate that the metric utilized is a dependable measure for assessing the probability of suicide.
	Notwithstanding the underlying principle of effectively predicting probable problematic behavior, there exists a proclivity to overlook or minimize unfavorable outcomes in order to progress the cadet to the subsequent phase of the recruitment procedure (Inwald & Thompson, 2021). Over the past year, several departments have implemented changes to their regulations, resulting in the recruitment of persons with questionable qualifications or mental unsuitability (Inwald & Thompson, 2021). Hence, the effectiveness of the screening measures depends on the following compliance with the measured outcomes.
Personality and Psychopathology Interplay
A major theme that emerged from the analysis of 13 articles on the MMPI-2-RF and police officers over the span of 2011 to 2021 is that mental illness can modify cognitive, emotional, and interpersonal inclinations, potentially impacting the behaviors and capabilities of law enforcement officers. The MMPI-2-RF is a comprehensive self-report inventory designed to evaluate a wide range of contemporary psychopathological symptoms and personality traits. The MMPI-2-RF elements are grouped into various scales that assess for clinical significance. The instrument measures criteria by which police candidates demonstrate actions that have the potential to hinder their effectiveness in fulfilling their professional duties.  One study identified the scores related to thought dysfunction are correlated with feelings of isolation and a lack of focus on achieving goals (Roberts et al., 2018).
	Psychopathology can profoundly modify personality, either in a positive or negative manner. For instance, it is possible that enduring a severe mental illness, could permanently influence one's cognitive, emotional, and interpersonal tendencies (Widiger, 2011). This modification of personality does not necessarily indicate just a persistent but mild expression of psychopathology. It may also signify the emergence of new personality traits because of the presence or encounter of psychopathology. The study findings suggest that the MMPI-2-RF spectrum scales show promise validity in evaluating psychopathology associated to personality disorders, in terms of criterion, concept, and incremental measures (Brown & Sellbom, 2020; Sellbom, 2019). It has been established that potential hazardous conduct in law enforcement professionals may be anticipated by analyzing their previous behaviors (Corey et al., 2018; Sellbom et al., 2021). Another study was implemented to explore the correlations between MMPI-2-RF and biodata, as well as post-hire metrics for performance, in a specific group of officers. They were deemed psychologically fit, were later employed, and had accessible records of their performance after being hired. The results suggest that combining MMPI-2-RF scores with biodata can enhance the accuracy of predicting undesirable outcomes (Corey et al., 2018). 
	The MMPI-2-RF had a revision and was subsequently renamed as MMPI-3 (Ben-Porath & Tellegen, 2020). The assessment has more than 300 items that are evaluated using numerous validity measures to detect inconsistent responses, exaggerated reporting, minimized reporting, and other relevant scales. In line with the findings of previous studies on the MMPI-2-RF, a recent investigation revealed a significant correlation between MMPI-3 scores and the post-10 dimensions (Whitman et al., 2021). The research derived exhibited convergent validity for assessing law enforcement officer candidates. However, some contend that the MMPI-2-RF is not without its shortcomings (Balthrop 2018; Corey & Ben-Porath, 2014). In situations when individuals are being assessed for employment, the deliberate deception of symptoms poses a significant challenge, especially when it involves downplaying, omitting, or minimizing pathological traits, emotions, or behavioral abnormalities. An inappropriate cadet may be erroneously sworn in due to false or inaccurate psychiatric reporting (Balthrop 2018; Corey & Ben-Porath, 2014). 
Criterion Validity and Predictive Accuracy
	An important finding based on reviewing 15 studies from 2014 to 2024 regarding the MMPI-3 and its use in pre-employment screening, demonstrates that the instrument is essential for identifying traits that could adversely affect police performance. The Minnesota Multiphasic Personality Inventory (MMPI) has consistently been one of the most extensively utilized psychological instruments in the assessment of police officer applicants during pre-hire screenings. The newest version, the MMPI-3, is a recently revised iteration of the MMPI-2-RF (Ben-Porath & Tellegen, 2020a,b). The MMPI-3 is inclusive of the POST-10 scales created by The California Commission on Peace Officer standards and Training (Spillberg & Corey, 2020).
The California Commission on Peace Officer standards and Training (Spilberg & Corey, 2020) mandates rigorous requirements that necessitate the evaluation of all recruits for law enforcement across various parameters: Emotional Regulation and Stress Tolerance, Avoidance of Substance Use and Other Risk-Taking Behavior, Impulse Control and Attention to Safety, Assertiveness, Social Competence, Teamwork, Decision Making and Judgment, Adaptability and Flexibility, Conscientiousness and Dependability, and Integrity and Ethics. A study examined the correlations between issues identified in pre-hire screenings of public safety candidates using the MMPI-3 assessment. The MMPI-3 scores showed regular and substantial associations with the POST-10 aspects. 
Previous studies have demonstrated that law enforcement professionals endure elevated levels of stress compared to individuals in most other professions and frequently suffer significant mental health issues (Price, 2017). The initial two peer-reviewed research focused on the examination of the MMPI-3 and its application in pre-employment screening for police officer candidates. These studies assessed the accuracy and practicality of using the MMPI-3 in this context (Whitman et al., 2021; Whitman et al., 2022). One study found that the MMPI-3 was not only effective in assessing police candidates but was also unable to find any indication to suggest significant or widespread differences in emotional or interpersonal issues that can be attributed to being subjected to occupational-related stressors (Whitman et al.,2022). The MMPI-3 PCIR identified 16 thresholds that were linked to a higher likelihood of experiencing difficulties in at least part of the POST-10 dimensions (Whitman et al., 2021). These findings of the research support the criterion validity of MMPI-3 scores in the pre-hire screening of police officers (Whitman et al., 2021). 
A recent study contributes to the existing body of literature on the interpretation of MMPI-3 results in pre-hire psychological examinations. It provides information on the frequencies of interpretable examinations, as well as the average scores and validity coefficients for MMPI-3 scores in a sample that includes nearly 2,000 public safety candidates. The findings confirmed the capacity to make accurate conclusions based on MMPI-3 scores across several groups, including police officers, correctional officers, dispatchers, firefighters, and male and female police officer applicants (Whitman et al., 2023). A supplementary analysis of 527 male and female police candidates revealed that there is no substantial disparity in the effectiveness of the MMPI-3 assessment tool between male and female candidates (Talerico et al., 2024). 
The MMPI-3 can detect both under reporting and over reporting as well. Research has demonstrated that both the MMPI-2 RF and MMPI-3 incorporate mechanisms to address the issue of deliberate underreporting within this specific group. This is advantageous, as the majority of applicants desire to present themselves in the most favorable light. The L-r and K-r validity measures have demonstrated use in detecting test takers who intentionally provide inaccurate or incomplete responses (Brown & Sellbom, 2019; Detrick & Chibnall, 2014; Tarescavage, Brewster, et al., 2015; Tarescavage, Fischler, et al., 2015). Another study supports the use of MMPI-3 and has determined that it's possible to detect response bias related to the over reporting of symptoms (Reeves et al., 2022). 
Utility of Neurocognitive Testing
The analysis of 7 papers on neurocognitive assessments reveals that they are widely acknowledged as a valuable tool for assessing the psychological capabilities of law enforcement professionals, particularly in the context of fitness-for-duty evaluations. Research has demonstrated that neurocognitive testing is a reliable method for evaluating psychological well-being, particularly in cases involving head injuries or dubious behavior by law enforcement officials (Berger et al., 2020) Testing of this nature can detect any impairments that may impact an officer's cognitive abilities, logical thinking, and conduct, which is essential for guaranteeing that police are competent in carrying out their responsibilities in a secure and efficient manner (Rimmer, 2022).
Although there is a scarcity of specific research on neurocognitive testing in stressful and demanding scenarios for police officers, a program designed to enhance officer decision-making in such circumstances yielded favorable results, indicating that neurocognitive testing may have advantages in this context (Dube et al., 2023). Nevertheless, further empirical evidence is required to substantiate the significance of neuropsychological testing in these particular situations. Moreover, studies conducted on police officers from various locations have demonstrated that neurocognitive assessments can effectively identify the cognitive skills that are pertinent to their professional responsibilities in ensuring public safety (Rabelo & Mazariolli, 2019). Barko et al. (2020) proposed the utilization of neurocognitive testing as a means to ascertain the attributes and psychological contraindications associated with achieving proficiency in the occupation of a patrol officer (Barko et al., 2020).	
Neurocognitive evaluation holds significant importance within the realm of response unit officers, as it enables the assessment of essential attributes like psychomotor skills, sensory-perceptual abilities, and cognitive processes (Ostapovych et al., 2020). Notwithstanding these findings, further investigation is warranted to have a more comprehensive understanding of the complete ramifications of neurocognitive testing on the performance of police officers, specifically within the Ugandan context (Wagner & Hout, 2019). Ultimately, the existing literature indicates that neurocognitive testing serves as a reliable method for evaluating the aptitude and abilities of police officers. However, additional research is required to investigate the full extent of its influence on performance and determine whether it should be adopted as a customary procedure in law enforcement organizations.
Discussion Research Question Two
Advocates frequently recommend mental health screening as a method to support the maintenance of a psychologically sound work environment. Personality tests are frequently conducted to screen and evaluate the mental well-being of prospective police cadets. Personality assessments are frequently carried out throughout the recruitment process for police officers. The MMPI-2 is extensively used in the process of selecting applicants. It has been employed to project the applicants who are most probable to excel in the role and do not possess personality features that are more vulnerable to mental illness. 
The MMPI-2-RF is another widely utilized mental health screening tool for prospective police officers. The results of the evidence synthesis revealed that the MMPI-2-RF possesses the capability to effectively forecast the susceptibility of police officers to potential behavioral and/or emotional difficulties. In addition, the integration of biodata with the MMPI-2-RF increases the capacity to assess and identify potential emotional and behavioral concerns. Nevertheless, critics argue that the MMPI-2-RF is not devoid of its limitations   During employment evaluations, intentionally deceiving symptoms presents a major obstacle, particularly when it entails minimizing, omitting, or downplaying pathological traits, emotions, or behavioral abnormalities. A cadet who is not suitable for the position may be mistakenly administered the oath of office because of misleading or incorrect scoring. (Balthrop 2018; Corey & Ben-Porath, 2014). 
The theory of constructed emotion incorporates both the physical and mental aspects, as the components of an emotional experience arise from innate bodily rhythms (Barrett & Satpute, 2019). Sleep dysregulation, digestive issues, sicknesses, and changes in consciousness caused by substances influence the perception of internal bodily sensations, emotions, and the body's ability to regulate its resources. Li et al. (2013) found that individuals with depression who died by suicide exhibit dysregulation in clock genes, which control circadian rhythm and indicate abnormalities with controlling energy. Individuals with impaired interoception, affect, and the allostatic or body budgeting system can be identified with the use of the MMPI-2 and MMPI-2-RF.
The theory of constructed emotion, which posits that emotions are constructed by multiple brain networks and are not triggered by dedicated circuits, supports neurocognitive testing by enhancing our understanding of how different neurocognitive processes contribute to emotional experiences. The theory of constructed emotion can provide a framework for defining emotional phenomena in terms of behavioral principles, which enhance cognitive approaches to emotion research (De Houwer & Hughes, 2018). Moreover, neurocognitive testing is informed by the theory through the development of performance-based tests that measure facets of emotion understanding based on componential emotion theory (Schlegel & Scherer, 2018). 
Research has also shown that brains' emotion networks can be identified and linked with various component processes such as valuation, appraisal, hedonic experience, and approach/avoidance tendencies, which are consistent with the theory of constructed emotion (Mohammadi et al., 2020). These neural networks support the identification of functional core processes of emotions, revealing the complexity with which different emotions emerge from coordinated activity across these networks. Recognizing subjective emotional experiences can be intensified by self-focused attention, indicating a dynamic relationship between subjective evaluation and objective neurophysiological data (Ito et al., 2023). Thus, neurocognitive testing methods can align with the theory of constructed emotion by harnessing a combination of subjective and objective data to analyze emotional states. In conclusion, the theory of constructed emotion underpins the process by which neurocognitive testing may assess emotional experiences, supporting the holistic understanding of how cognitive, psychological, and brain mechanisms collectively give rise to emotions.
Results Research Question Three
Psychological illnesses are common within the law enforcement population, but many police officers seem hesitant to seek treatment for mental health issues. Considering the widespread occurrence and significant consequences of poor mental health within the field of law enforcement, it is imperative to identify methods to enhance the utilization of mental health resources available to police officers. The primary obstacles that impede police officers from getting mental health therapy are stigma, police culture, and confidentiality. All three obstacles contribute to the apprehension over the repercussions of having a mental health disorder. RQ 3 included the analysis of 28 articles. 
Stigma as a Deterrent 
The comprehensive analysis of 15 articles determined that the presence of stigma presents a significant obstacle for police officers seeking mental health care. Police officers and members are particularly susceptible to the detrimental impacts of stigma. Up to 33% of police officers have experienced the adverse consequences of stigma surrounding mental health concerns (Haugen et al., 2017; Wheeler et al., 2018). Moreover, police officers have a higher propensity to embrace stigma, possess a pessimistic perspective about rehabilitation, and refrain from seeking aid (Soomro & Yanos, 2019). 
The results indicate that within the law enforcement population, there is a prevailing fear of discussing or seeking help for mental health issues. This is due to the perception that such conditions are grounds for disqualification from a career in law enforcement (Bell & Palmer-Conn, 2018; Caitlin et al., 2022; Haugen et al., 2017; Jetelina et al., 2020; Richards et al., 2021). Police officers may exhibit reluctance in seeking assistance due to apprehensions over confidentiality, which is reasonable considering the pervasive social disapproval associated with mental health intervention (Bell & Palmer-Conn, 2018; Caitlin et al., 2022; Haugen et al., 2017; Jetelina et al., 2020; Richards et al., 2021). 
The primary difficulties to seeking therapy were identified as the fear of being viewed as weak or unfit for law enforcement job, concerns about jeopardizing one's professional prospects, and the impact of cultural stigmatization on psychological services (Drew & Martin, 2021; Haugen et al., 2017; Soomro & Yanos, 2019; Wheeler et al., 2018). Drew and Marin (2021) concluded a significant number of law enforcement officers suffering from mental illnesses are not receiving adequate psychological care due to the negative social perception around such conditions. The study revealed that even police officers who received mental health therapy expressed a significant degree of ambivalence due to the associated stigma. The results of another study align closely with the outcomes of prior studies, which identified factors such as reluctance to reveal mental struggles, apprehension regarding societal attitudes towards individuals with mental disorders, and resentment towards those who choose to pursue treatment or receive a clinical diagnosis (Burzee et al., 2022).
The Impact of Police Subculture
The exhaustive examination of 13 articles concluded that police officers demonstrate resistance in seeking mental health services as a result of the impact of the police subculture. Efficient law enforcement is crucial for diminishing criminal activity and guaranteeing the well-being of the general population. Police personnel frequently encounter distressing occurrences as they carry out their duties. Lack of sufficient assistance can result in a decline in the mental well-being of a police officer when exposed to such situations for an extended period. Due to the prevailing police subculture, particularly the adverse views surrounding accepting treatment for mental health issues, numerous police officers experience distress in solitude, further contributing to their emotional decline. 
	Although mental illness is common in the law enforcement population, the police culture has historically been unwilling to embrace interventions aimed at addressing this issue. Although the mental well-being of a police officer is contingent upon the subculture and leadership style inside their organization (Deschenes et al., 2018), police officers are far from feeling at ease with seeking and obtaining therapy because of the shared norms and beliefs within the police organization (Cohen et al., 2019). Law enforcement personnel frequently exhibit reluctance in seeking assistance for matters pertaining to their mental health (Ricciardelli et al., 2020; Watson & Andrews, 2018).  A study conducted by Carleton et al. (2020) reveals that more than 50% of law enforcement officers rarely undergo any treatment. 
The phenomenon of the 'cult of masculinity' has garnered much scrutiny as an enduring and detrimental element of police culture (Silversti, 2017). The perception of mental health issues within law enforcement agencies is significantly shaped by traditional machismo attitudes, leading to a stigma. The police force is primarily composed of males and exhibits a resilient cultural image. The concept of mental illness as a vulnerability is prevalent among law enforcement personnel (Bell & Eski, 2016; Velazquez & Hernandez, 2019). 
Studies have revealed a strong correlation between cultural biases against mental illness and the law enforcement subculture, resulting in a significant prevalence of structural stigma. The traditional obstacles faced by police officers in pursuing therapy entail the negative perception and prevailing mindset within law enforcement that dissuades attempts towards mental well-being (Rodriguez et al., 2023). The culture inside the police force is marked by a negative perception towards seeking treatment, apprehensions about the boundaries of confidentiality, and doubts about the pertinence and effectiveness of available treatment options (Rodriguez et al., 2023; White et al., 2016). 
Discussion Research Question Three
	The prevalence of stigma within the law enforcement community is highly consequential. The law enforcement community exhibits a heightened demand for mental health intervention, yet concurrently faces a more pronounced prevalence of cultural disapproval in comparison to the general population. Police officers experience heightened anxiety due to the existence of stigma, as they are concerned about the potential breach of confidentiality and the negative impact on their professional standing.  It is imperative to undergo a significant transformation in the attitudes of police officers towards seeking treatment to reduce the stigma. 
The existence of the police subculture contributes to the perpetuation of the negative perception associated with mental health treatment. Despite the prevalence of mental illness among law enforcement personnel, the police culture has traditionally shown reluctance in accepting treatments designed to tackle this problem. Altering the risk associated with being a law enforcement officer and the likelihood of developing a mental illness due to the cumulative stress and trauma will pose significant challenges. The subculture that disapproves of seeking help will likely be less challenging to change. 
The prevailing stigma is partly attributed to the perspectives within the police subculture. A shift in police subculture will be imperative to diminish the number of police officers afflicted with mental illness who are responsible for maintaining societal safety. The transition should commence with the administrators and initiate promptly during the academy. The academy may not only incorporate physical agility standards, but also resiliency interventions and be inclusive of a therapy prerequisite. 
The theory of constructed emotion suggests that emotional experiences are formed and influenced within social, cultural, and linguistic environments. Emotion categories are culturally contingent constructs employed to classify comparable experiences, rather than universally objective realities (Gendron et al., 2014). The theory of constructed emotion, which asserts that emotions are shaped by previous experiences, cultural influences, and situational circumstances rather than solely biological responses, provides insight into the emotional dynamics within police subculture and its approach to the stigmatization of mental health. This particular subculture is characterized by a set of beliefs that emphasize resilience and stoicism. These values have a significant impact on officers, leading them to repress their emotions and perceive requesting mental health assistance as a vulnerability. This perspective is influenced by communal standards, personal backgrounds, and the challenging nature of the work environment. The theory additionally implies potential avenues for transformation, placing emphasis on the notion that the introduction of good experiences pertaining to mental health has the capacity to reconstruct emotional reactions and mitigate stigmatization. Leadership and training are crucial factors in the process of shifting sub-cultural norms, placing emphasis on mental well-being, and confronting prevailing stigmas. Consequently, these factors contribute to fostering a transition towards more positive attitudes regarding mental health within the law enforcement community.
Results Research Question Four

Throughout their tenure, police officers may encounter numerous distressing incidents. Police officers exhibit significantly elevated rates of post-traumatic stress disorder (PTSD), suicidal tendencies, and substance misuse compared to the general population. Cognitive behavioral therapy (CBT), trauma therapy, eye movement desensitization reprocessing (EMDR), and mindfulness are all scientifically supported methods that effectively address the mental health challenges experienced by police officers. MDMA is a novel approach that is becoming increasingly popular for the management of post-traumatic stress disorder (PTSD). RQ 3 included the analysis of 53 articles. 
Efficacy and Superiority of CBT 
The examination of 14 articles on Cognitive behavioral therapy (CBT) found that it is an empirically validated psychological intervention that successfully targets a range of mental health disorders frequently observed among law enforcement personnel, including anxiety, depression, and substance abuse (Gautam et al., 2020; Moorey & Hollon, 2021; Vasile, 2020). Research has demonstrated that anti-depressant drugs exhibit comparable efficacy to CBT in the treatment of depression. Some researchers have obtained similar results, demonstrating that both anti-depressant medication and cognitive behavioral therapy are equally beneficial in reducing symptoms of depression (Beshai et al., 2019; Dunlop et al., 2017). 
A meta-analysis findings demonstrated a notable decrease in symptoms of post-traumatic stress disorder, depression, and anxiety because of psychological therapies. The data further demonstrated that CBT had significantly greater efficacy compared to alternative therapies in treating post-traumatic stress disorder (Alshahrani et al., 2022). The findings of a separate study align with previous research that confirms the effectiveness of cognitive behavioral therapy. This study saw a significant decrease in symptoms of post-traumatic stress disorder after undergoing the treatment (Hassan & Holmes, 2023). 
The rising popularity of telehealth enables individuals to receive medical care from the comfort of their own residences via computer or telephone. This could be an appealing choice for the law enforcement community, which is usually focused on maintaining privacy and confidentiality. A comprehensive examination of the current computerized CBT platforms was carried out, revealing its efficacy as a remedy for low mood (Hofman & Asmundson, 2017; Lui, 2021). Supporting these studies are two meta-analyses that have been carried out, which have found that computerized CBT is equally effective compared to traditional CBT (Carlbring et al., 2017; Wright et al., 2019). Along with computerized cognitive behavioral therapy, telephone-based cognitive behavioral therapy has demonstrated potential as a successful intervention for depression (Cujipers et al., 2019; Luo et al., 2020). 
Comprehensive approach to therapy 
The examination of 10 articles indicates that eye movement desensitization and reprocessing therapy (EMDR) is a comprehensive therapeutic approach suitable for police officers and first responders who have undergone trauma. EMDR not only addresses the immediate symptoms of trauma but also tackles the broader challenges they face in interpersonal relationships, emotional well-being, and behavioral aspects. This therapy takes into consideration the specific needs of officers in these areas, with the goal of aiding them in overcoming trauma-related difficulties and promoting personal growth and development (Laliotis et al., 2021). Thorough research has established EMDR as an exceptionally effective treatment for post-traumatic stress disorder (PTSD), with multiple studies consistently demonstrating its efficacy in individuals affected by this debilitating mental health condition (de Jongh et al., 2019; Laugharne et al., 2016; Van den Berg et al., 2015). 
Research has determined that eye movement desensitization and reprocessing (EMDR) is an effective approach to alleviate work-related trauma symptoms among first responders (Morris et al., 2022). Other studies have also supported the effectiveness of EMDR in addressing post-traumatic stress disorder, anxiety, and depression experienced by first responders in the line of duty (Jarero et al., 2019; Torchalla & Strehlau, 2018). Additionally, a meta-analysis has provided evidence supporting the utilization of EMDR as a potentially effective method for treating depression (Dominguez et al., 2021).
Eye movement desensitization and reprocessing (EMDR) has been in existence for more than 30 years. According to a study conducted by Torchalla and Strehlau in 2018, EMDR has proven to be effective in alleviating symptoms associated with post-traumatic stress disorder (PTSD) and facilitating the return of police personnel to their professional duties. Over the course of several decades, EMDR treatment has undergone significant development, transitioning from a simple technique aimed at reducing sensitivity for treating PTSD to a comprehensive psychotherapeutic approach that addresses a wide range of clinical concerns across various contexts and client populations (Laliotis et al., 2021).
Cognitive, Emotional, and Behavioral Enhancement
A thorough examination of 12 academic studies revealed that mindfulness is a highly effective strategy in reducing symptoms related to stress, anxiety, and depression. Mindfulness can be described as a complex procedure that necessitates the collaboration of various interconnected cognitive mechanisms, which mutually amplify and reinforce one another. At the core of this process lies the ability to concentrate on the present moment, encompassing internal cognitive processes, emotions, physical sensations, behaviors, and the external environment. Engaging in mindfulness entails adopting a focused and empathetic mindset that diminishes or eliminates automatic responses to current situations, as well as subsequent evaluations, predictions, analyses, and criticisms of what has transpired (Ribeiro et al., 2019).
Research provides substantial evidence that engaging in mindfulness practice results in long-lasting enhancements in an individual's brain functioning, emotional well-being, and behavioral patterns (Hansen et al., 2016; Ruffault et al., 2017). A recent study revealed that mindfulness meditation yielded a notable stress-alleviating impact on police officers. It unveiled a decline in the participants' hostility and stress levels, an enhancement in their emotional state, and a boost in their capacity to regulate their emotions. There is increasing data indicating that police officers who engage in mindfulness practices may help reduce the mental and physical impacts of stress (Ribeiro et al., 2019; Fisher et al., 2019; Kaplan et al., 2018). 
Several research studies have provided evidence supporting the effectiveness of mindfulness in treating various conditions, including anxiety, depression, burnout, and post-traumatic stress disorder (PTSD). Recent data suggests that mindfulness may also offer benefits in alleviating symptoms of depression (Khatib et al., 2022; Krick & Felfe, 2019). Specifically, investigations have been carried out to evaluate the impact of mindfulness on law enforcement officers. These studies have found improvements in areas such as fatigue, sleep quality, anxiety levels, and PTSD (Christopher et al., 2018; Grupe et al., 2019; Hoeve et al., 2021).
Emergence of MDMA-Assisted Therapy
Post-traumatic stress disorder (PTSD) is a prevalent condition in the police population of the United States. A thorough examination of nine articles has determined that Methylenedioxymethamphetamine (MDMA) holds potential as an effective method for alleviating symptoms associated with PTSD. Recent research indicates that MDMA is an innovative therapeutic drug with promise in the treatment of this disorder. Mental health professionals previously utilized MDMA to address various psychiatric conditions before its classification as a restricted substance. In recent years, MDMA has emerged as a promising treatment option for PTSD, and findings from randomized controlled trials support its use as an effective pharmacological therapy when combined with psychotherapy (Latimer et al., 2021).
Numerous phase II clinical trials were carried out to evaluate the effectiveness of MDMA-assisted therapy in treating post-traumatic stress disorder (PTSD). Participants diagnosed with PTSD, who had undergone at least three months of antidepressant medication and six months of psychotherapy without experiencing any improvement in symptoms, were included in the trials. Surprisingly, after just two sessions of MDMA-assisted therapy, slightly over half of the participants no longer displayed symptoms severe enough to meet the criteria for a PTSD diagnosis (Mithoefer et al., 2019). Subsequently, following an additional session, this percentage increased to two-thirds (Mitchell et al., 2021). Remarkably, this percentage remained stable during the one-year follow-up period (Jerome et al., 2020) and further rose to nearly 75% four years after the completion of the MDMA therapy sessions. 
Phase III trials began in 2021 and showed similar results to Phase II. The analysis of Phase III data suggests that MDMA-assisted therapy is highly effective, safe, and well-received by participants. This therapeutic approach has great potential for transforming the management of PTSD (Mitchell et al., 2021). Furthermore, other studies have demonstrated that administering MDMA to a group of 90 individuals with persistent post-traumatic stress disorder not only reduced the severity of their symptoms but also improved their self-perception (Slomski, 2021). One study indicates that while there is a slight risk of adverse effects associated with MDMA-assisted therapy, its impact on depression symptoms is only moderate (Smith et al., 2022). This meta-analysis provides additional support to the growing body of research suggesting the potential of MDMA-assisted therapy in alleviating PTSD symptoms (Illingsworth et al., 2021). Another meta-analysis has found that MDMA-assisted therapy could be beneficial for individuals suffering from chronic and treatment-resistant post-traumatic stress disorder (Bahji, 2020).
Peer Support Reduces Stigma
	An analysis of 8 articles elucidated the pivotal role of peer support initiatives among police officers in augmenting mental health awareness, mitigating stigma within the fraternity, and sustaining officers during their transition to civilian lifestyles, as exemplified by an examination of peer support mechanisms within the York Regional Police (Milliard, 2020). Moreover, the perception of overarching organizational support has emerged as a critical determinant in officers’ propensity to engage with Employee Assistance Programs (EAP). Notably, a diminution in the perceived robustness of organizational support correlates with an elevated probability of officers advocating for peer support among their colleagues (Quick, 2023). 
	According to Milliard (2020), peer support programs within police forces are pivotal in enhancing officers' mental health literacy. Not only do these initiatives help in identifying and understanding symptoms of mental health issues among peers, but they also play a crucial role in dismantling the stigma associated with seeking help for mental health concerns within police organizations. The systematic provision of peer support is seen as effective in changing attitudes towards mental health and encouraging officers to engage in discussions about mental health issues openly and without fear of judgment (Milliard, 2020). Peer support programs have been recognized as a viable mental health intervention to alleviate organizational stress and trauma for public safety workers, such as correctional officers, in addition to addressing mental health literacy and reducing stigma (Fallon et al., 2023). The objective of these programs is to normalize the occurrences of stress and trauma, diminishing the social disapproval associated with these matters and fostering a culture where seeking assistance is regarded as a virtue rather than a flaw.
	 The efficacy of peer support programs entails the mitigation of stigma associated with mental health and suicide prevention endeavors, with a special emphasis on the younger population. According to Wright-Berryman et al. (2022), peer support plays a crucial role in mitigating the stigma associated with suicide by facilitating open communication and helping, hence potentially averting potential crises. The study conducted by Khayati et al. (2023) investigates the influence of peer and family support on the reduction of stigma experienced by individuals diagnosed with HIV/AIDS. Police peer support programs can benefit from similar mechanisms of support, understanding, and acceptance. This demonstrates the extensive advantages of peer support in creating a supportive community, which in turn reduces internal and acquired stigma and improves overall well-being.
	Venville et al. (2022) highlight the role of peer support in aiding police veterans during their transition from active duty to civilian life. The elements of identity, belonging, and access to a supportive police community are emphasized as crucial for navigating this transition effectively, with peer support acting as a catalyst for hope and new possibilities in civilian life.
Quick (2023) further explores the relationship between perceived organizational support and the effectiveness of employee assistance programs (EAPs) as recommended by peers. The findings suggest that improving officer receptivity to mental health support may be best achieved through peer recommendations, indicating the significant influence that peer support has on an officer’s willingness to engage with mental health resources.
Discussion Research Question Four

	 An evidence synthesis was undertaken to explore various methodologies utilized in addressing mental health concerns frequently encountered by law enforcement personnel. The methodologies include cognitive behavioral therapy, eye movement desensitization and reprocessing, and mindfulness techniques. The findings suggest that each approach demonstrates a high level of efficacy in managing the prevailing conditions, including anxiety, depression, stress, and post-traumatic stress disorder, among individuals employed in law enforcement. Moreover, empirical studies have demonstrated encouraging results in the utilization of Methylenedioxymethamphetamine as a supplementary therapeutic approach for the management of post-traumatic stress disorder.
The usefulness of cognitive behavioral therapy in resolving mental health illnesses commonly associated with the police profession has been proven. Furthermore, this intervention exhibits a high level of accessibility, as it can provide comparable efficacy when delivered remotely via computer-based therapy. The notion that the therapy can be delivered via a computer within the confines of an individual's residence is anticipated to significantly mitigate apprehensions pertaining to minimized exposure and the pursuit of confidential healthcare. The findings of this study suggest that eye movement desensitization and reprocessing could be a promising and effective method for treating post-traumatic stress disorder, anxiety, and depression in first responders who experience these conditions while performing their job responsibilities. The findings of the evidence synthesis indicate that EMDR therapy exhibits comparable efficacy to cognitive behavioral therapy, which is widely recognized as the established norm for trauma treatment. Additionally, EMDR therapy is found to be a more economically viable approach (de Jongh et al., 2019; Laugharne et al., 2016; Van den Berg et al., 2015).
Research provides substantial evidence that engaging in mindfulness practice results in long-lasting enhancements in an individual's brain, emotions, and behaviors. According to Kabat-zin (1990), mindfulness refers to the intentional cognitive activity of focusing one's attention on a particular object of observation in the present moment, while refraining from making evaluative judgments. The findings of the evidence synthesis indicate that mindfulness has beneficial effects due to its ability to decrease aggression, improve mood, foster self-awareness and self-care, and alleviate the physiological and psychological consequences of stress. Numerous studies have shown compelling data supporting the notion that the practice of mindfulness yields enduring improvements in an individual's cognitive abilities, emotional state, and behavioral tendencies (de vibe et al., 2012; Hansen et al., 2016; Ruffault et al., 2017).
Peer support initiatives among police officers are essential for promoting mental health awareness, reducing stigma, and aiding officers in transitioning to civilian life. These programs enhance mental health literacy, encourage open discussions, and normalize seeking help. Peer support also plays a crucial role in suicide prevention, stigma reduction, and aiding police veterans in their transition. Additionally, the perceived organizational support influences officers' engagement with mental health resources, with peer recommendations being particularly effective.
MDMA-assisted therapy is a novel therapeutic approach that has emerged in recent times and demonstrates potential. The treatment is experiencing progress in clinical trials and is widely anticipated to have a profound impact on patients diagnosed with post-traumatic stress disorder. Based on the findings of the study, it has been observed that the utilization of MDMA-assisted therapy yields a prompt and efficacious therapeutic outcome for individuals afflicted with severe post-traumatic stress disorder, as well as other associated disorders including depression, alcohol and substance abuse, and childhood trauma. The efficacy of MDMA-assisted therapy in the treatment of severe post-traumatic stress disorder (PTSD) and its potential to improve safety has been demonstrated. MDMA-assisted therapy has the potential to greatly transform the treatment of post-traumatic stress disorder as compared to existing treatment treatments. Therefore, it should be swiftly evaluated for clinical use. 
According to Barrett (2017), the theory of constructive emotion suggests that interoception is an essential element of the brain's internal physiology and is generated from the process of allostasis. Allostasis is not a physiological state of the human body, but rather a regulatory process employed by the brain to manage the body's equilibrium by considering the associated benefits and drawbacks. To attain peak performance, the brain must possess the ability to anticipate the body's needs and meet them in a proactive manner. The theory of constructive emotion posits that the efficacy of several therapeutic approaches, including cognitive behavioral therapy, eye movement desensitization reprocessing, mindfulness, and MDMA, is contingent upon the attainment of mental, physical, and emotional equilibrium. 
The theory of constructed emotion, which views emotions as products of the brain’s integration of sensory inputs, past experiences, and conceptual knowledge, offers insight into the workings of psychotherapeutic methods like CBT, EMDR, mindfulness, and MDMA-assisted therapy. These treatments interact with the brain’s emotional construction processes to foster healthier emotional responses. CBT and EMDR focus on restructuring cognitive and memory-based contributors to maladaptive emotions, while mindfulness shifts the relationship with emotional stimuli towards acceptance. MDMA-assisted therapy offers a unique approach by altering the emotional context of therapeutic sessions, aiding in the reconstruction of emotional experiences related to trauma. This analysis underscores the adaptability of emotional responses and the potential of these therapies to intervene effectively in the emotional construction process, leading to improved mental health outcomes.
The theory of constructive emotion posits that the brain's main role is to anticipate and react to the body's metabolic demands by proactively initiating actions to meet those needs. The brain upholds the process of allostasis through the continuous construction of a mental image that encompasses both the internal state of the body and the external surroundings. Exhaustion of unrejuvenated metabolic resources can result in distress and fatigue. The brain's predictive modeling of the body causes changes in energy control, which in turn affects individuals experiencing mood fluctuations (Shaffer et al., 2022). According to Barrett et al. (2016), cognitive behavioral therapy and eye movement desensitization and reprocessing therapy have demonstrated significant effectiveness in treating depression. These therapeutic approaches aim to facilitate the modification of individuals' predictions by potentially enhancing their capacity to process prediction errors and improve their comprehension of concepts. The notion of manufactured emotion posits that the practice of mindfulness serves to alleviate the impact of allostasis overload. The practice of mindfulness has been found to be a viable strategy for managing the energy imbalance resulting from stressful experiences, since it helps to alleviate the impact of allostasis excess. Furthermore, prior studies have shown evidence that mindfulness possesses the capability to augment an individual's enduring ability to concentrate on interoceptive experiences (Farb et al., 2013). 
The theory of constructed emotion suggests emotions result from the brain’s construction based on past experiences, cultural norms, and the immediate environment, rather than being merely biological responses. This framework significantly aligns with the dynamics within law enforcement, where the culture notably influences officers’ perceptions and reactions, especially towards stress and mental health. Police peer support programs, grounded in shared experiences and an understanding of the police subculture, offer a tailored approach to address these challenges. They facilitate emotional well-being by allowing officers to reshape their understanding of seeking help from being viewed as a weakness to an act of resilience, thereby reducing the stigma surrounding mental health. Through trust, shared cultural context, and the normalization of discussing mental health issues, these programs effectively reconstruct officers’ emotional responses, promoting coping and resilience within the unique stressors of police work. This alignment showcases the programs’ efficacy in enhancing officers’ mental health and emotional support through the lens of constructed emotion theory, illustrating a positive shift in emotional construction regarding mental health and support-seeking behaviors among law enforcement personnel.
Summary
Over the past decade, a notable and continuous rise in suicide rates among United States (US) law enforcement officers has been observed, underscoring an urgent need to provide these officers with essential skills and resources to improve their mental health. This systematic review delves into the pivotal factors responsible for or contributing to the psychological distress encountered by police officers, thoroughly analyzing their implications. The theory of constructed emotion offers insights into how lived experiences of police officers shape their anticipatory reactions to contemporary incidents and foster the development of traumatic responses. Furthermore, this review elucidates the stressors, psychological dynamics, and experiences that detrimentally affect their mental health based on the review of findings, themes, and scenarios addressed by the four research questions, alongside outcomes concerning the increased suicide incidents within the US law enforcement community. It also investigates the effectiveness of mental health screening protocols aimed at pinpointing trainees at risk, therapeutic interventions effective for conditions prevalent among law enforcement personnel, and the key reasons behind their hesitancy to pursue mental health services.

Based on chapter 4 of dissertation, does the chapter 1 overview need revised? The law enforcement profession is intrinsically stressful and is comprised of psychological, physical, administrative, professional and organizational stressors (Violanti et al., 2017). A meta-analysis of law enforcement stressors and health outcomes indicated that repeated exposure to organizational stressors were associated with poor physical and mental health (Goh et al., 2015). In addition to organizational stress, however, officers experience other stressors that are unique to the profession (Violanti et al., 2017). Various operational stressors to include shift work and long hours can also be experienced in other professions but the top five stressors in the law enforcement profession are most commonly associated with law enforcement duties. This includes the physical/psychological stress from exposure to beaten or deceased children, killing someone in the line of duty, having partner killed in the line of duty, incidents involving a use of force and being physically attacked (Violanti et al., 2017). 
When compared to the general population, law enforcement officers experience high rates of depression, anxiety, posttraumatic stress disorder (PTSD), and suicide (Dawson, 2019). The suicide rate among law enforcement officers is consistently higher than the suicide rate among the general population. Some factors that contribute to the rising rates of suicide include stress, pre-trauma, peri-trauma, post-trauma, police culture, public scrutiny, and alcoholism (National Suicide Awareness For Law Enforcement Officers Program [SAFLEO], 2020).
The impact of the police job on officers' mental health is examined in this doctoral systematic literature review.  I will also examine the barriers to accessing mental health resources that law enforcement officers face such as the stigma, lack of organizational support and lack of confidential resources. Finally, current treatment programs for law enforcement officers will be examined to dissect what effectively treats law enforcement officers.