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An operational stress injury (OSI) is a term used most often to describe mental disorders which result from, or are exacerbated by, military or police service. In the Canadian context, this most often refers to active or former members of the Canadian Armed Forces (CAF) or the Royal Canadian Mounted Police (RCMP). The most common diagnoses within this term include post-traumatic stress disorder (PTSD), anxiety disorders, depression, and substance use disorders.
- mental health
- operational stress injury
- post-traumatic
- recovery
Operational stress injury (OSI) is a non-clinical and non-medical term apparently coined by Veterans Affairs Canada [1] yet applicable elsewhere and used to describe a distinct category of occupational stress injury, referring to mental health challenges related to military or police service (the latter reserved in Canada for service in the Royal Canadian Mounted Police (RCMP)) [2]. Occupational stress injuries encompass a broad range of psychological and related conditions resulting from work-related activities that interfere with a person’s professional and personal life, including anxiety, depressive, trauma- and stressor-related, and substance-related disorders [3][4]. Operational stressors that may result in OSI can include service-related events beyond combat, such as service-related accidents in unrelated to combat activities, as well as sexual trauma caused by peers and others involved in one’s service. OSIs do not relate to injuries that are not associated with service. For example, grief from the loss of a loved one outside the service during active service is not typically a cause of OSI, although if it is associated with lack of support by service peers and/or supervisors, that can cause OSI (sometimes termed consequential OSI). Due to the common stress hypersensitivity related to post-traumatic and other OSI-related experiences, people with OSIs often develop anxiety and substance-related disorders, e.g., as learned stress intolerance and as (maladaptive) self-help coping, respectively.
The recognition of operational stress injuries (OSIs) traces back to earlier periods in history, with notable observations of the psychological impact of combat experiences on soldiers dating back to the mid-19th century. During World War I, the notion of shell shock was addressed, highlighting the psychological toll of warfare on military personnel [5]. However, it was later in the 20th century when the term “post-traumatic stress disorder” (PTSD) was coined, reflecting a deeper understanding of the condition and its broader manifestations beyond the context of combat experiences [6]. Key breakthroughs in the late 1990s and early 2000s furthered awareness of mental health issues in the military and law enforcement communities. Research efforts shed light on the prevalence and impact of OSIs, paving the way for proactive support approaches and comprehensive programs focused on OSI prevention, diagnosis, and treatment. While the term OSI is most commonly used and understood in Canadian settings when referring to military or police service, it is also relevant internationally and to other first responder populations. In any cultural context, as long as the injury develops during, as a result of, or is worsened by, military/police service, then it can be considered an OSI.
Despite progress, fully comprehending OSI’s scope and complexity remains a challenge and hence disrupts related care. OSIs encompass various mental disorders as noted above [1]. The lack of a coherent and comprehensive description of OSI in the peer-reviewed literature requires further scholarly work and publication. OSIs are common among military personnel and RCMP members, often co-occurring with physical health challenges [7]. The study of OSIs is important due to their considerably disruptive impact on individuals and their social supports [8], including considerable suffering and dysfunction; as well, it is important to address related resilience and post-traumatic growth [9].
OSI remains a critical issue requiring ongoing research and collaboration to effectively support military personnel, veterans, and RCMP (and other police forces’) members and retirees. Understanding OSI’s history and current status is important for further research and development including in relation to best practices in order to reduce incidence and enhance recovery in relation to OSIs.
This entry aims to provide a comprehensive yet concise overview of OSIs, encompassing diagnosis-specific and transdiagnostic aspects. By examining symptomatology, epidemiology, etiology, treatment, and lived experience, valuable insights will be offered here for all stakeholders, such as mental health care providers, policymakers, and service users.
This entry is adapted from the peer-reviewed paper 10.3390/encyclopedia3040095
References
- Veterans Affairs Canada Veterans Affairs Canada Understanding Mental Health 2023. Available online: https://www.veterans.gc.ca/eng/health-support/mental-health-and-wellness/understanding-mental-health#03 (accessed on 28 July 2023).
- Smith-MacDonald, L.; Pike, A.; Jones, C.; Bremault-Phillips, S. Exploration of Trauma-Oriented Retreats: Quantitative Changes in Mental Health Measures for Canadian Military Members, Veterans and Royal Canadian Mounted Police with Posttraumatic Stress Disorder and Moral Injury. Trauma Care 2022, 2, 114–130.
- Antony, J.; Brar, R.; Khan, P.A.; Ghassemi, M.; Nincic, V.; Sharpe, J.P.; Straus, S.E.; Tricco, A.C. Interventions for the Prevention and Management of Occupational Stress Injury in First Responders: A Rapid Overview of Reviews. Syst. Rev. 2020, 9, 121.
- Senate Canada Interim Report on the Occupational Stress Injuries of Canada’s Veterans 2015. Available online: https://publications.gc.ca/site/eng/9.802281/publication.html (accessed on 31 July 2023).
- Black, W.G. Social Work in World War I: A Method Lost. Soc. Serv. Rev. 1991, 65, 379–402.
- Institute of Medicine. Treatment for Posttraumatic Stress Disorder in Military and Veteran Populations: Initial Assessment; The National Academies Press: Washington, DC, USA, 2012; ISBN 978-0-309-25421-2.
- Higgins, D.M.; Kerns, R.D.; Brandt, C.A.; Haskell, S.G.; Bathulapalli, H.; Gilliam, W.; Goulet, J.L. Persistent Pain and Comorbidity among Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn Veterans. Pain Med. 2014, 15, 782–790.
- Norris, D.; Schwartz, K.D.; Eichler, M.; Tam-Seto, L.; Mahar, A.; Smith-Evans, K.; Cramm, H. A Qualitative Study of the Capabilities of Family Members of Veterans Living with Operational Stress Injuries. Fam. Relat. 2022.
- Tsai, J.; Mota, N.P.; Southwick, S.M.; Pietrzak, R.H. What Doesn’t Kill You Makes You Stronger: A National Study of U.S. Military Veterans. J. Affect. Disord. 2016, 189, 269–271.
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