With sweltering units, remote locations, and low pay, prisons in the Lone Star State have long struggled with high officer turnover and vacancy rates.

But, based on findings from one study in Washington, there could be another factor impacting officer retention in corrections: PTSD.

A study published recently in the American Journal of Industrial Medicine found that PTSD is as prevalent among prison guards as it is among Iraq and Afghanistan veterans, and more prevalent than it is among police officers.

Co-authored by Washington State University assistant professor Lois James and University of Alabama at Birmingham assistant professor Natalie Todak, the research relied on surveys sent to several thousand corrections employees in Washington state. Of the more than 300 who responded, 19 percent met the criteria for PTSD.

READ MORE: Prison turnover leaves units understaffed

Recently, James spoke to Chronicle reporter Keri Blakinger about the study, whether the findings would likely apply in other states, and what's behind the problem.The following are edited exercpts.

Q: So, first of all, what prompted you to look at PTSD in prison guards?

A: The original assessment was actually conducted in 2014 and it was an overall assessment of correction employee health and wellness generally. So originally the focus wasn't specific to PTSD, it was really to get a good snapshot of all of the stressors they face - sleep loss, general health, physical health. But one of the things that interested me so much in PTSD was there's not been a huge amount done on it in corrections.

Q: So you broke the other surveys in the assessment out into separate papers - what did those find?

A: The first was on sleep and then a response article. The sleep one was really quite shocking, the level of sleep restriction that prison workers were facing. We found that they were getting massively insufficient sleep - we also found very high rates of insomnia. And quite high rates of nightmares.

Q: And in the more recent work, the PTSD findings, what did you find?

A: The overall percentage of prison workers that suffer PTSD we found to be 19 percent which is comparable to modern war veterans, veterans returning from Iraq and Afghanistan. A little bit higher than the rates of PTSD in police officers, and they're a population that's known to be at risk for PTSD. So you know it's definitely concerning - and even among those that did not reach the clinical cut-off point for PTSD we were still seeing strong evidence of PTSD-type symptoms.

Q: So how did you measure PTSD - or, rather, what are the signs?

A: We were using the PCL-5, a very well established questionnaire that's used by clinicians to determine the clinical cut-off points for PTSD. It was included in a whole battery of questionnaires in the study - about sleep, exposure to critical incidents - and through combining those questionnaires we were able to dig deeper.

Q: Why do you think it's as high as veterans? It's probably not surprising that prison jobs might be traumatic but it seems that people might be surprised that they generate quite that level of trauma?

A: Although really, really traumatic critical instances can of course trigger PTSD there's more and more knowledge emerging that the "lower level" trauma - the chronic exposure to human suffering and hardship - that can cause PTSD as well. It doesn't have to be one massive thing that happens to you. It can be across the course of several years, and that's typical to prison work. Most of the people in the sample have witnessed pretty severe suffering.

Q: So that severe suffering raises a question - what about PTSD among inmates?

A: I've had several people reach out to me since publishing and ask what about the inmates. I think it's interesting, often people assume that there's this huge barrier between the inmates and the corrections officers. There's this cynicism that the COs wouldn't care about the inmates but it's not actually the case because the witnessing of inmate suffering is really correlated to developing PTSD.

Q: Corrections is an industry that's had a lot of problems with retention; do you think this factors into it?

A: Absolutely - no doubt at all. In fact, one of the things that was predictive of PTSD was job ambiguity, not feeling secure in management, not feeling that you're getting secure supervision. If you feel like you're in a position where mistakes can be made and you're going to be hung out to dry for them if they are made, that's not a comforting place to be. We assume this is a CO problem but actually it's just a consequence of working behind the walls and being in that environment generally.

Q: Within the populations you looked at, were there any demographics more likely to be impacted?

A: Black prison employees and women were at significantly higher risk for PTSD. And we also found that greater time on the job was predictive of greater PTSD. And, interestingly, being assigned to night shift was associated with less PTSD. In policing, night shift work tends to be associated with greater problems.

Q: So you looked at prisons - but is it different in county jails?

A: That's a great question that unfortunately we can't really answer from this. I have little reason to suspect that it would be different. If anything the jail can be even more unpredictable and volatile.

keri.blakinger@chron.com

@keribla