302 Suicide and Life-Threatening Behavior 33(3) Fall 2003

 2003 The American Association of Suicidology

Suicidal Ideation and Attempts

in Norwegian Police
ANNE MARIE BERG, MA, ERLEND HEM, MD, BJØRN LAU, PHD,
MITCHELL LOEB, MSC, AND ØIVIND EKEBERG, MD

Studies on suicide among police show inconsistent results, thereby contrib-

uting to considerable speculation regarding why police officers commit suicide.
The present paper is the first nationwide study on suicidal ideation and attempts
among police. 3,272 Norwegian police completed Paykel’s Suicidal Feelings in the
General Population questionnaire. Lifetime prevalence of specific questionnaire
items ranged from 24% for the feeling that life was not worth living, 6.4% for
having seriously considered suicide, and 0.7% for attempted suicide. Independent
predictors of serious suicidal ideation were marital status, subjective health com-
plaints, reality weakness, anxiety, and depression. Serious suicidal ideation was
mainly attributed to personal and family problems.

Suicide in police has been described as an ep-
idemic (Loo, 2001; Violanti, 1996). It has
been claimed that the suicide rate of law en-
forcement personnel is between two and three
times that of the general population (Mohan-
die & Hatcher, 1999; Slovenko, 1999). Re-
cently, we published the first systematic re-
view of suicide in police in which strict
methodological inclusion criteria were ap-
plied to original studies. The review con-
cluded that an elevated suicide rate in police
ANNE MARIE BERG is with the National
Police Academy in Oslo, Norway. ERLEND HEM,
BJØRN LAU, and ØIVIND EKEBERG are with the
Department of Behavioral Sciences in Medicine,
Faculty of Medicine at the University of Oslo.
MITCHELL LOEB is with SINTEF Unimed, Health
Services Research in Oslo.
Funding for this project was provided by
the Norwegian Department of Justice and the
Norwegian Foundation for Health and Rehabili-
tation.
Address correspondence to Anne Marie Berg,
The National Police Academy, P.O. Box 5027
Majorstua, NO-0301 Oslo, Norway; E-mail:
anne.m.berg@politihs.no
has not been documented (Hem, Berg, &
Ekeberg, 2001). A particular problem of
previous research has been methodological
flaws.
There has been considerable specula-
tion regarding why police officers commit
suicide, and numerous theories have been
proposed (Violanti, 1996). It is argued that
policing is one of the most dangerous, stress-
ful, and health-threatening occupations, with
high levels of stress, alcoholism, divorce, sui-
cide, and so forth associated with this profes-
sion (Hill & Clawson, 1988). However, the
suggestions have been highly speculative, and
there has been a call for studies examining
causal factors of police suicide (Loo, 1986).
Police officers are prone to sudden and unex-
pected situations, violence, and the potential
death of both others and themselves. This
threat may have psychological consequences,
such as posttraumatic stress disorder or burn-
out, which are often assumed to contribute
to suicidal behavior (Schmidtke, Fricke, &
Lester, 1999). Shift work, the public’s anti-
police sentiments, and access to firearms are
also mentioned as potential explanations.
BERG ET AL.
Earlier studies among police have main-
ly focused on suicide. The motivation for re-
search on suicidal ideation and attempts is
that attempted suicide is both one of the
strongest predictors of completed suicide and
an important indicator of extreme emotional
distress and psychological suffering. More-
over, identification of both the risk of suicide,
and prevention of suicide based on risk fac-
tors, have proven to be difficult. Thus it has
been proposed that risk factors for morbidity
preceding suicide, especially depressive mood,
suicidal ideation, and attempted suicide should
be studied. It is hoped that a better under-
standing of the pathways that lead to suicide
as well as the early identification and treat-
ment of suicidal ideation may reduce rates of
both attempted and completed suicide (Hin-
tikka, Viinamäki, Tanskanen, Kontula, & Kos-
kela, 1998). To our knowledge, only one pre-
vious paper has studied suicidal ideation
among police (Lennings, 1995). This was a
small pilot study from Queensland, Australia,
investigating suicidal ideation among a group
of students and police officers (N = 118).
Only 30 of the participants were police offi-
cers. Suicidal ideation was measured on the
Suicide Ideation Scale (total scores can range
from 10 to 50). In this study, the mean sui-
cidal ideation score was 12.4 in both groups.
There are few national surveys of the
prevalence of suicidal ideation; however, Weiss-
man et al. (1999) recently reported data from
nine countries. The rates of suicide ideation
varied widely by country, while the rates of
suicide attempts were more consistent across
most countries. In the U.S. National Comor-
bidity Survey, the lifetime prevalence of sui-
cidal ideation was 13.5%, suicidal planning
3.9%, and suicidal attempt 4.6% (Kessler,
Borges, & Walters, 1999). The lack of uni-
form methodology makes comparisons diffi-
cult. Prevalence rates in different studies vary
widely due to the different settings, popu-
lations, age groups, definitions of suicidal
ideation, assessment instruments, and retro-
spective timeframe for presence of suicidal
ideation (Burless & De Leo, 2001). Unfortu-
nately, there is no nationwide data of suicidal
ideation and suicide attempts in the general
303
population in Norway. Studies have been con-
ducted among adolescents, medical students,
and physicians (Hem, Grønvold, Aasland, &
Ekeberg, 2000; Tyssen, Vaglum, Grønvold, &
Ekeberg, 2001; Wichstrøm & Rossow, 2002).
The aims of the present study are to
investigate: (1) the prevalence of suicidal ide-
ation and suicide attempts in a nationwide
study of Norwegian police, (2) predictors of
serious suicidal ideation, and (3) the factors
to which police attribute their serious sui-
cidal ideation.
TERMINOLOGY
There is no consistent terminology in
the area of suicidal problems, leading to a
somewhat bewildering situation (Renberg,
2001). In this study, the terms suicidal ideation
and suicidal attempts are used. Suicidal ide-
ation is described by the first four questions
in Paykel’s Suicidal Feelings in the General
Population questionnaire (see the discussion
under Methods), while a suicidal attempt is
described in the last question in this ques-
tionnaire (Paykel, Myers, Lindenthal, & Tan-
ner, 1974).
This study includes not only police of-
ficers, but also middle managers and manag-
ers in the police force. Hence, the term police
is used to describe the general sample.
METHODS
Participants
On a worldwide basis, police in Nor-
way are well educated. Until 1992, a person
had to undertake 2 years of training to be-
come a Norwegian police officer. After 1992
the training expanded to 3 years of unpaid
full-time study at The National Police Acad-
emy, which is governed by The Department
of Justice. The police in this study are all
members of the largest police organization
in Norway—The Norwegian Police Union.
Approximately 95% of all police officers are
members of this organization.
304 SUICIDAL IDEATION IN NORWEGIAN POLICE

In December 2000 a questionnaire was to the letter, which was a response rate of
distributed by the organization, presumably 70%. The results showed that 26% never re-
to all the 6,398 members who were trained ceived the questionnaire. Based on this fig-
police officers. The questionnaire included 396 ure, the true response rate would be 51/74 ×
questions on background information, physi- 100 = 69%. Since this is an indirect measure,
cal and mental health, working condition, job we will not be too conclusive about this fig-
dissatisfaction, burnout, coping, personality, ure; however, we are sure that the true re-
and suicidal ideation. It was an anonymous sponse rate is closer to 69% than to 51%. Of
questionnaire, and it was distributed once. those who originally received the question-
Several reminders were distributed through naire there is reason to believe that approxi-
trade union representatives, and the internal mately two-thirds have answered the ques-
data system within the police force (G-mail). tionnaire.
At the same time it became clear that many Of the police who responded to the
members had not received the questionnaire. questionnaire, 16% were female, which is
It is unclear whether this was due to chance an accurate reflection of the distribution of
or systematic mistakes. Thus, the final re- women in the police force (17.9%, informa-
sponse rate was 51%, which represents a to- tion collected from The Department of Jus-
tal of 3,272 persons who completed and re- tice). A total of 79 persons did not answer the
turned the questionnaire (see Table 1). question about gender, 51 persons did not
Due to the problems in distributing answer the question regarding civil status,
the questionnaire, the project manager dis- and 14 persons did not answer the question
tributed 680 letters to randomly selected po- about position; these individuals were ex-
lice in November 2001. The letters included cluded from the analyses. The age of partici-
two questions: first, “Did you receive the pants ranged from 20 to 66 years of age, with
questionnaire?”, and second, “If you received a mean age of 38.9 years (SD = 8.7); the
it, did you answer it?”. The responses were mean age of men was 39.7 (SD = 7.0), and for
yes and no. A total of 475 persons responded women 34.0 years (SD = 8.7) (p < .001). The
mean age of all members of the Norwegian
Police Union is 40.2; with males and females
TABLE 1
having a mean age of 41 and 35 years, respec-
Description of Sample
tively. The sample in this study is about 1
Frequency Percent year younger than the whole population ac-
cording to the mean age. Officers are over-
Gender represented in the study in proportion to the
Women 501 15.7 general police population (65.3% vs. 56.1%),
Men 2,692 84.3 while managers are underrepresented (2.9%
Age (years) vs. 9.6%).
20–29 509 16.1
30–39 1,175 37.1
40–49 1,047 33.0
Suicidal Behavior
50–59 430 13.6
60–69 9 0.3 The prevalence of suicidal ideation and
Civil status attempts was assessed by a modified question-
Single 342 10.6 naire, originally introduced by Paykel et al.
Married/cohabitant 2,715 84.0 (1974). Paykel’s Suicidal Feelings in the Gen-
Separated/divorced 164 5.1 eral Population questionnaire contains five
Widow(er) 11 0.3 questions:
Occupational level
Manager 96 2.9 1. Have you ever felt that life was not
Middle manager 1,034 31.7
worth living?
Officer 2,128 65.3
2. Have you ever wished you were dead
BERG ET AL.
(for instance, that you could get to
sleep and not wake up)?
3. Have you ever thought of taking
your life, even if you would not re-
ally do it? [These three questions
had the four following response cat-
egories: often, sometimes, hardly ever,
never. Before the statistical analyses,
the responses were dichotomized into
never (0) and any frequency (1), ac-
cording to Paykel’s original work.]
4. Have you ever reached the point
where you seriously considered tak-
ing your life, or perhaps made plans
how you would go about doing it?
[This question contained six re-
sponse possibilities: never, once, 2–3
times, 4–5 times, 6–9 times, and at
least 10 times.]
5. Have you ever made an attempt to
take your life? [This question had four
response possibilities: never, once,
twice, and three times or more. Re-
sponses to the last two questions were
dichotomized into never (0) and any
frequency (1) prior to statistical anal-
yses.]
Questions four and five contained an addi-
tional subquestion: “To what extent do you
think the following factors influenced you to
consider taking your life?” with the follow-
ing response categories: personal problems,
family problems, social problems, problems
connected with police profession, and other
problems. The responses could be indicated
as: not at all, a little, somewhat, quite a lot,
and very much. In the multivariate analyses,
“ever seriously considered taking your life”
was used as the dependent variable. The ques-
tionnaire has been applied in several other
studies, including Norway (Hem et al., 2000;
Tyssen et al., 2001) and Sweden (Renberg,
2001).
Somatic Health Complaints
The subjective experience of health
was assessed by a 10-item version of the Sub-
jective Health Complaint (SHC) question-
305
naire, previously referred to as the Ursin
Health Inventory (UHI). This questionnaire
consists of questions examining the occur-
rence, extroversion, and duration of pain in
the neck, back, feet, arms and shoulders; pain
in the chest; migraine and headache; diges-
tive problems; and vertigo for the last 30 days
(Eriksen, Ihlebæk, & Ursin, 1999; Ursin, En-
dresen, & Ursin, 1988). The items are scored
on a 4-point rating scale ranging from no
complaints (0) to serious complaints (3). In the
present study, the SHC sum score was trans-
formed to a dichotomous variable. Consis-
tent with a previous study (Aasland, Olff, Fal-
kum, Schweder, & Ursin, 1997), those who
had a response of 2 or 3 on at least one of
the ten items were scored as “cases.” Accord-
ing to this procedure, 40.7% (women: 46.2%;
men: 39.7%) were considered a case.
Anxiety and depression
The Hospital Anxiety and Depression
Scale (HADS; Zigmond & Snaith, 1983) in-
cludes 14 questions, divided into two sub-
scales: an anxiety subscale and a depression
subscale. Each subscale contains seven items,
and is scored on a 4-point scale. HADS has
been found to perform well in assessing the
prevalence and symptom severity of anxiety
disorders and depression in both somatic,
psychiatric, and primary care patients, as well
as in the general population (Bjelland, Dahl,
Haug, & Neckelmann, 2002). As indicated in
Table 2, female police had higher mean scores
on the anxiety subscale, but lower scores on
the depression subscale.
Personality
The personality inventory used in this
study was the Basic Character Inventory (BCI),
which is based on an original questionnaire
constructed by Lazare, Klerman, and Armor
(1966) and modified by Torgersen (1980).
This instrument contains 36 items that mea-
sure four different dimensions of personality:
neuroticism, extroversion, control/compul-
siveness, and reality weakness. BCI is based
on the “big three” personality dimensions
306 SUICIDAL IDEATION IN NORWEGIAN POLICE

TABLE 2
Descriptive Statistics for Independent Variables and t-Statistics for Gender Differences

All Women Men

t-statistics
M SD M SD M SD p

Job Satisfaction Scale (JSS) 44.27 9.25 43.54 8.83 44.38 9.33 .60
Emotional exhaustion (MBI) 2.23 0.69 2.14 0.64 2.25 0.70 .002**
Depersonalization (MBI) 2.24 0.75 2.12 0.68 2.26 0.76 .000***
Personal accomplishment (MBI) 2.43 0.41 2.48 0.42 2.42 0.41 .003**
Anxiety subscale (HADS) 1.54 0.42 1.59 0.42 1.53 0.42 .001**
Depression subscale (HADS) 1.42 0.41 1.34 0.36 1.44 0.42 .000***
Subjective Health Complaint (SHC) 0.41 0.49 0.46 0.50 0.40 0.49 .008**
Neuroticism (BCI) 0.28 0.23 0.39 0.25 0.26 0.23 .000***
Extroversion (BCI) 0.58 0.27 0.66 0.25 0.57 0.27 .000***
Control/compulsiveness (BCI) 0.48 0.24 0.49 0.25 0.48 0.24 .328
Reality weakness (BCI) 0.14 0.17 0.15 0.19 0.13 0.17 .018*

Note. *p < 0.05, **p < 0.01, ***p < 0.001.

(neuroticism, extroversion, and control/com- 1 (extremely satisfied) to 7 (extremely dissatis-

pulsiveness), with an additional fourth di-
mension (reality weakness). The neuroticism
factor closely resembles the classic neuroti-
cism scales, the extroversion scale measures
extroversion/introversion, the control/compul-
siveness dimension assesses the degree of
compulsiveness, and reality weakness measures
chronic illusions, paranoid traits, and prob-
lems with identity-insecurity and relations—
traits that are associated with severe person-
ality disorders (Torgersen & Alnæs, 1989).
Each dimension is based on nine questions
with a dichotomous response (0 = not apply,
1 = apply), allowing each dimension a range
of scores between 0 (low) and 1 (high). Female
police had higher mean scores on neuroti-
cism, extroversion, and reality weakness. No
significant gender differences were found on
the control/compulsiveness dimension (see Ta-
ble 2 for details).
Job Dissatisfaction
fied) and summed to provide an overall score
ranging from 10 (high satisfaction) to 70 (low
satisfaction). There were no differences in score
between males and females (see Table 2).
Burnout
Burnout was measured with a 22-item
version of the Maslach Burnout Inventory
(MBI). MBI has been shown to provide reli-
able data and valid findings and is generally
considered the gold standard measure for
burnout (Maslach, Schaufeli, & Leiter, 2001).
The inventory contains questions regarding
three factors that specify burnout: emotional
exhaustion, depersonalization (cynicism), and
personal accomplishment. The items are scored
on a 5-point scale. Male police were found to
have higher mean scores on the dimensions
of emotional exhaustion and depersonaliza-
tion, while female police scored higher on
personal accomplishment.

The Job Satisfaction Scale ( JSS) con- Statistics

sists of ten questions examining various as-
pects of working conditions and stressors (re-
sponsibility, variation, collaboration, salary,
working hours, etc.) (Warr, Cook, & Wall,
1979). All items are scored on a scale from
The χ2 test was used to examine group
differences, and the t-test was used to test
differences on continuous data. Simultaneous
effects were analyzed through logistic regres-
BERG ET AL. 307

sion models. The level of significance was set
at 0.05.
RESULTS
As can be seen in Table 3, 24% of the
police had, on one or more occasions, felt
that life was not worth living; 6.4% had seri-
ously considered suicide; and 0.7% had at-
tempted suicide. Compared to men, signifi-
cantly more female police had once or more
“felt that life was not worth living” (χ2 = 5.6;
p < .02), “wished you were dead” (χ2 = 7.2; p <
.01), and “made a suicide attempt” (χ2 = 10.6;
p = .001). There were no gender differences
in “thoughts of taking my life” and “seriously
considered taking my life.” Furthermore, there
were no gender differences in suicidal ide-
ation during the previous year.
As can be seen from Table 4, serious sui-
cidal ideation was bivariately associated with
separated/divorced marital status, age above
40 years, job dissatisfaction, subjective health
complaints, three personality traits, anxiety, de-
pression, and burnout. All independent vari-
ables were entered in a logistic regression
analysis to predict serious suicidal ideation.
In this adjusted model, only marital status,
subjective health complaints, the personality
trait of reality weakness, anxiety and depres-
sion, and personal accomplishment remained
significant. The other variables that were sig-
nificant in the bivariate analyses became non-
significant in the adjusted model because of
high intercorrelations, especially for anxiety
and depression. That the burnout compo-
nent of personal accomplishment and the
civil status category became significant pre-
dictors in the adjusted model implicates that
these variables were statistically repressed in
the bivariate model. However, we were not
able to identify single variables responsible
for these effects.
In another analysis, all independent
variables were entered in a logistic regression
analysis to predict suicidal attempt. Despite
a low number (n = 22), and hence, wide con-
fidence intervals, the model showed four sig-
nificant independent predictors: being female
(OR = 3.27, 95% CI = 1.19–8.95), separated/
divorced civil status (OR = 6.43, 95% CI =
2.02–20.51), anxiety (OR = 4.15, 95% CI =
1.09–15.82), and the burnout dimension per-
sonal accomplishment (OR = 0.23, 95% CI =
0.09–0.59).
As can be seen in Figure 1, female
police related their serious suicidal ideation

TABLE 3
Prevalence of Suicidal Ideation and Attempts in Norwegian Police

Total respondents Ever N (%) Last year N (%)

All Women Men All Women Men All Women Men

Felt life was not worth living 3,142 493 2,649 755 139* 616* 279 44 235
(24.0) (28.2) (23.3) (8.9) (8.9) (8.9)
Wished you were dead 2,795 437 2,358 489 96** 393** 198 31 167
(17.5) (22.0) (16.7) (7.1) (7.1) (7.1)
Thought of taking your life 3,075 484 2,591 694 118 576 230 40 190
(22.6) (24.4) (22.2) (7.5) (8.3) (7.3)
Seriously considered taking 3,046 483 2,563 194 38 156 52 4 48
your life (6.4) (7.9) (6.1) (1.7) (0.8) (1.9)
Attempted suicide 3,057 482 2,575 22 9** 13** 2 0 2
(0.7) (1.9) (0.5) (0.1) (—) (0.1)

Note. Gender differences are marked with an asterisk (*).

*p < 0.05, **p < 0.01.
308 SUICIDAL IDEATION IN NORWEGIAN POLICE

TABLE 4
Predictors of Serious Suicidal Ideation in Norwegian Police

Adjusted model (n = 2,751)

Crude (bivariate) (multivariate)

OR 95% CI OR 95% CI

Gender
Men —
Women 1.31 0.91 1.89 1.08 0.69 1.69
Age
20–29 —
30–39 1.42 0.87 2.32 1.24 0.71 2.16
40–49 1.77* 1.09 2.88 1.57 0.85 2.90
50–59 1.82* 1.04 3.20 1.81 0.86 3.80
Civil status1
Married/cohabitant —
Single 1.47 0.96 2.26 2.08* 1.24 3.50
Separated/divorced 2.76** 1.72 4.43 2.46** 1.43 4.25
Occupational level
Officer —
Manager 0.80 0.32 2.00 0.73 0.27 1.99
Middle manager 0.84 0.61 1.16 0.67 0.44 1.02
Job Satisfaction Scale (JSS)+ 1.87*** 1.38 2.54 0.94 0.66 1.33
Emotional exhaustion (MBI)+ 3.06*** 2.20 4.27 1.41 0.93 2.16
Depersonalization (MBI)+ 1.93*** 1.42 2.63 1.10 0.77 1.58
Personal accomplishment (MBI)+ 0.95 0.71 1.27 0.67* 0.48 0.93
Anxiety (HADS)+ 4.02*** 2.89 5.60 1.77** 1.20 2.62
Depression (HADS)+ 4.34*** 3.09 6.10 2.08*** 1.38 3.12
Subjective Health Complaint (SHC) 2.57*** 1.91 3.47 1.59** 1.13 2.25
Vulnerability (BCI)+ 2.57*** 1.91 3.47 1.31 0.91 1.86
Intensity (BCI)+ .83 .62 1.11 1.08 0.78 1.50
Control (BCI)+ 1.40* 1.05 1.86 1.01 0.74 1.39
Reality weakness (BCI)+ 3.88*** 2.70 5.56 2.07** 1.38 3.12

Note. 1Widow(er) was omitted from the analyses due to the low number.
+
These scores were transformed into z-scores and dichotomized at the 50th percentile.
*p < 0.05, **p < 0.01, ***p < 0.001.

mainly to personal problems (82.9%), fol- DISCUSSION

lowed by family problems (63.9%), social
problems (31.3%), and work problems (6.7%).
Male police related serious suicidal ideation
to personal problems (52.4%) and family prob-
lems (47.5%), and considered work problems
to be of significantly higher importance than
females. More female police considered per-
sonal and social problems as important im-
pacting factors on serious suicidal ideation;
however, female police on average present-
ed 2.2 attributions, compared to 1.7 among
male police.
The results in this study show a low
prevalence of serious suicidal ideation and
attempts among police. When compared to
Norwegian physicians, the findings show that
physicians have about 50% more serious sui-
cidal ideation (10.4%) and attempts (1.6%)
than police (Hem et al., 2000). There were
significantly more women who reported hav-
ing ever attempted suicide, although there
were no gender differences in serious suicidal
ideation during the previous year.
BERG ET AL.
Note. Gender differences marked with an asterisk (*)
*p < .05
Figure 1. Impacting factors on serious suicidal ideation in Norwegian police (n = 194).
Comparisons with other studies of sui-
cidal behavior are difficult, because most gen-
eral population studies have developed their
own questions to measure suicidality (Bur-
less & De Leo, 2001). Moreover, Paykel’s
classic work was based on interviews, while
the present study is a postal survey. A rele-
vant comparison with the present study is a
study in a general population in Sweden,
comparing results from Paykel’s question-
naire between 1986 and 1996. The lifetime
prevalence of serious suicidal ideation was
10.4% and 13.1%, respectively (Renberg,
2001). Among Norwegian medical students
and physicians, the corresponding figures
were 8.4% and 10.4%, respectively (Hem et
al., 2000; Tyssen et al., 2001). All these fig-
ures from comparable studies are higher than
in the present police sample (6.4%).
The clinical significance of fleeting
thoughts that life is not worth living is still
not sufficiently explored. Therefore, we em-
309
phasize the question about serious suicidal
ideation, because this is a very important
clinical point in the questionnaire (i.e., ex-
pression of some kind of suicidal planning),
and the relatively large number of respon-
dents is necessary to employ multivariate an-
alytic techniques.
Predictors of Serious Suicidal Ideation
Predictors of suicidal ideation are not
quite the same as predictors of suicide; how-
ever, data suggest that suicidal ideation is the
best predictor of suicidal acts (Ahrens, Lin-
den, Zäske, & Berzewski, 2000). Further, sui-
cidal attempts and suicide are two overlap-
ping phenomena with a very similar pattern
of risk factors (Beautrais, 2001). Some of the
present results represent expected predictors,
such as marital status, anxiety, and depres-
sion. These findings have been replicated in
310
a large number of studies, both for suicidal
ideation, suicide attempts, and suicide.
We found job dissatisfaction to predict
suicidal ideation bivariately, although this was
not the case in the model that controlled for
other factors (see Table 4). That job dissat-
isfaction became nonsignificant in the mul-
tivariate model was mainly due to its as-
sociation with anxiety and depression. This
implies that low job dissatisfaction increases
the risk of suicidal ideation through an in-
creased level of anxiety and depression. In
other words, those who are dissatisfied with
their job in the police without being de-
pressed or anxious do not have an elevated
risk of suicidal ideation.
In accordance with the findings in the
study of Norwegian physicians (Hem et al.,
2000), subjective health complaints were found
to be a predictor of suicidal ideation. The
current literature addressing the issue of an
association between subjective health com-
plaints and suicidal ideation remains limited
(Nakao, Yamanaka, & Kuboki, 2002). In a re-
cent study from a psychosomatic clinic in
Japan, suicidal ideation was statistically and
independently associated with 15 major so-
matic symptoms (Nakao et al., 2002). Our re-
sults are in accordance with this study, show-
ing a relationship between suicidal ideation
and subjective health complaints, when con-
trolled for well-known predictors like anxiety
and depression. This indicates that for some
persons, suicidal ideation occurs without an
accompanying subjective experience of anxi-
ety or depression, but is associated with so-
matic complaints. Our findings show that the
subjective health condition is of importance;
alternatively, it demonstrates that this condi-
tion is all part of a general distress syndrome.
Consequently, somatic complaints should be
taken seriously in the police population, also
with respect to potential suicidality.
In the present sample, the personal-
ity factor of reality weakness was a significant
predictor in the multivariate model. This per-
sonality factor was also important in an ear-
lier study among Norwegian physicians, where
it was found to predict the transition from
suicidal thoughts to plans (Tyssen, Hem, Vag-
SUICIDAL IDEATION IN NORWEGIAN POLICE
lum, Grønvold, & Ekeberg, 2002). Reality
weakness might represent a risk factor for
suicidal behavior because it is related to se-
vere personality disorders. Consequently, re-
ality weakness is an important personality trait
to be considered in further studies of suicid-
ality. The personality factors of neuroticism
and control/compulsiveness were found to be
significant predictors of suicidal ideation in
the bivariate analyses, but not in the adjusted
model. Neuroticism dropped out because of
its association with anxiety and depression,
while no single variable was responsible for
control/compulsiveness not being a signifi-
cant contributor in the adjusted model. A
vulnerable police officer appears to have more
suicidal ideation because he or she is more
often depressed and anxious.
We found that the burnout compo-
nents of emotional exhaustion and deperson-
alization (cynicism) predicted suicidal ide-
ation in the bivariate analyses, but failed to
do so in the adjusted model. This was partly
due to their correlations with depression and
anxiety. Some of the discussion about burn-
out has focused on issues of discriminant
validity. Is burnout truly a distinctly different
phenomenon from depression? The present
view is that burnout is a problem that is
specific to the work context, which contrasts
with depression, which tends to pervade ev-
ery domain of a person’s life (Maslach et al.,
2001). Although burnout and depression are
considered distinct constructs, our results in-
dicate that the burnout components of emo-
tional exhaustion and depersonalization only
predict suicidal ideation through depression
and anxiety. The finding that personal ac-
complishment was a significant predictor in
the multivariate analyses both for serious sui-
cidal ideation and suicidal attempt could not
be explained by any single variables. This is a
surprising finding, and may represent an arti-
fact. However, this remains to be investigated
more thoroughly in future studies.
There are some gender differences in
the pattern of factors that led to suicidal ide-
ation in the police population. Both female
and male police consider personal problems
as the most important factor in suicidal ide-
BERG ET AL.
ation, being 82.9% and 52.4% of respondents,
respectively. When personal and, partially,
family problems can be reasonably coped
with, other kinds of stress may be better tol-
erated. On the other hand, when problems at
home become too overwhelming, the risk of
suicide may increase. Compared with fe-
males, male police more often attributed sui-
cidal ideation to work problems. In addition,
female police had a higher number of attri-
butions. With respect to gender differences,
similar attribution was made by physicians, al-
though female physicians are more like male
police (Hem et al., 2000).
Strengths and Limitations
The strength of the study is that it is a
nationwide study, and represents all occupa-
tional levels in the police force. In addition,
the large number of respondents makes mul-
tivariate analysis feasible. It remains unclear,
however, whether the respondents provided
honest answers in the questionnaire, which
includes personal questions on suicidal ide-
ation and attempts (Renberg, 2001). It is rec-
ognized that respondents tend toward more
socially desirable responses in interviews than
with self-administered questionnaires (Oka-
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Manuscript Received: July 16, 2002
Revision Accepted: February 28, 2003