Risk factors for adverse health in military and law enforcement personnel; an umbrella review

BACKGROUND: A better understanding of adverse health and underlying risk factors in the context of military and law enforcement is essential to developing future preventative strategies. We conducted an umbrella review to provide an overview of the current literature regarding risk factors for adverse health in military and law enforcement populations.

METHODS: We systematically searched the literature for systematic reviews and meta-analyses regarding risk factors for adverse health in military or law enforcement populations. We critically appraised the studies that matched our inclusion criteria, extracted the adverse health outcomes and underlying risk factors, and narratively synthesised the findings.

RESULTS: This umbrella review included 34 systematic reviews that covered data from 43 countries. We identified twenty-six adverse health outcomes and 220 underlying risk factors. The adverse health outcomes covered in the included systematic reviews were one infectious disease (Heliobacter pylori infection); two endocrine, nutritional, or metabolic diseases (metabolic syndrome and obesity); seven mental, behavioural, or neurodevelopmental disorders (adjustment disorder, alcohol misuse, anxiety, depression, poor mental health, PTSD, and stress); two diseases of the nervous system (insomnia and sleep-disordered breathing); one disease of the ear or mastoid process (noise-induced hearing loss); eight diseases of the musculoskeletal system and connective tissue (cervical spine injuries, injuries, lower extremity injuries, musculoskeletal injuries, neck pain, rhabdomyolysis, and stress fractures); one symptom, signs and abnormal clinical and laboratory findings, not elsewhere classified (suicidal ideation); three injuries, poisonings, or other consequences of external causes (concussion, heat illness, and suicide); and one factor influencing health status and contact with health services (burnout). Of the 220 identified risk factors, 136 were modifiable, and the most frequently reported were female sex, older age, lower functional movement screen scores, maladaptive coping, lack of social support, and neuroticism.

CONCLUSION: This umbrella review identified twenty-six adverse health outcomes and their underlying risk factors in military and law enforcement populations. Hereby, this study provides potential starting points for preventing adverse health in these populations. It also identifies a broad lack of systematic reviews investigating mental, behavioural, or neurodevelopmental disorders in military populations and diseases of the musculoskeletal system and connective tissue in law enforcement populations.

PROSPERO REGISTRATION NUMBER: CRD42022378123.