Operational Stress Injury Research Articles

Operational Stress Injuries in Disaster Responders: A Framework for Supporting Mental Health in Climate Crisis.

The rising occurrence of natural disasters linked to climate change has drawn the attention of disaster response leaders to the significance of addressing operational stress injuries among disaster response personnel. We define and describe operational stress injuries in this workforce and explore theoretical frameworks that can inform the development of programs and interventions to mitigate these effects. We aim to establish a conceptual framework for understanding an operational stress injury by introducing a model specific to disaster responders. We also emphasize strategies that can be employed within a stress injury awareness framework to promote the mental well-being of those who respond to climate-related disasters.

Perspectives and Experiences of Public Safety Personnel Engaged in a Peer-Led Workplace Reintegration Program Post Critical Incident or Operational Stress Injury: A Qualitative Thematic Analysis.

Public safety personnel (PSP) experience operational stress injuries (OSIs), which can put them at increased risk of experiencing mental health and functional challenges. Such challenges can result in PSP needing to take time away from the workplace. An unsuccessful workplace reintegration process may contribute to further personal challenges for PSP and their families as well as staffing shortages that adversely affect PSP organizations. The Canadian Workplace Reintegration Program (RP) has seen a global scale and spread in recent years. However, there remains a lack of evidence-based literature on this topic and the RP specifically. The current qualitative study was designed to explore the perspectives of PSP who had engaged in a Workplace RP due to experiencing a potentially psychologically injurious event or OSI. A qualitative thematic analysis analyzed interview data from 26 PSP who completed the RP. The researchers identified five themes: (1) the impact of stigma on service engagement; (2) the importance of short-term critical incident (STCI) program; (3) strengths of RP; (4) barriers and areas of improvement for the RP; and (5) support outside the RP. Preliminary results were favorable, but further research is needed to address the effectiveness, efficacy, and utility of the RP. By addressing workplace reintegration through innovation and research, future initiatives and RP iterations can provide the best possible service and support to PSP and their communities.

Workplace Reintegration Programs, Policies, and Procedures for Nurses Experiencing Operational Stress Injury: A Scoping Literature Review.

Nurses experience elevated rates of operational stress injuries (OSIs). This can necessitate taking leave from work and subsequently engaging in a workplace reintegration process. An unsuccessful process can have long term impacts on a nurse's career, affecting the individual, their family, and broader community, while contributing to nursing shortages. A knowledge gap regarding the workplace reintegration of nurses experiencing mental health challenges, impedes the development and implementation of initiatives that might increase the success of nurses reintegrating into the workplace. This scoping review explored the existing literature concerning workplace reintegration for nurses experiencing OSIs. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) reporting guidelines were utilized. Three key search terms across six databases were employed followed by a qualitative content analysis of the resulting literature. Eight documents were included. The literature exhibited high heterogeneity in objectives, content, and article types. The content analysis revealed five themes: (1) recognizing stigma, (2) elements of successful workplace reintegration, (3) considerations for military nurses, (4) considerations for nurses with substance use disorders, and (5) gaps in the existing literature. A paucity of programs, policies, procedures, and research exists regarding workplace reintegration for nurses facing mental health challenges. It is imperative to recognize that nurses may experience OSIs, necessitating mental health support, time off work, and operationally/culturally-specific assistance in returning to work. Innovative and evidence-based approaches to workplace reintegration are needed to enhance the retention of a skilled, experienced, compassionate, and healthy nursing workforce.

‘There’s no club, absolutely nothing’: Experiences of parents of Veterans living with illnesses and injuries in Canada

LAY SUMMARY Parents of Veterans are often excluded from literature or programs surrounding military and Veteran families. Parents can play an important role in their adult child’s life following an operational stress injury. Little research has been done to look at how supporting an adult child may affect the parents. Parents of Canadian Armed Forces Veterans were interviewed to discuss their experiences supporting an ill or injured adult child. Parents reported taking on many additional responsibilities and often feel worried, guilty, and lost. These demands impacted their own health, well-being, finances, jobs, and relationships. They described feeling forgotten and betrayed by the lack of support and programs available for them. It is important that all parents are given the support and programs required, demonstrating a need for more in-depth explorations of what families of Veterans experience and need in Canada.

Applying the Theoretical Domains Framework to identify police, fire, and paramedic preferences for accessing mental health care in a First Responder Operational Stress Injury Clinic: a qualitative study.

First responders and other public safety personnel (PSP; e.g. correctional workers, firefighters, paramedics, police, public safety communicators) are often exposed to events that have the potential to be psychologically traumatizing. Such exposures may contribute to poor mental health outcomes and a greater need to seek mental health care. However, a theoretically driven, structured qualitative study of barriers and facilitators of help-seeking behaviours has not yet been undertaken in this population. This study used the Theoretical Domains Framework (TDF) to identify and better understand critical barriers and facilitators of help-seeking and accessing mental health care for a planned First Responder Operational Stress Injury (OSI) clinic. We conducted face-to-face, one-on-one semistructured interviews with 24 first responders (11 firefighters, five paramedics, and eight police officers), recruited using purposive and snowball sampling. Interviews were analyzed using deductive content analysis. The TDF guided study design, interview content, data collection, and analysis. The most reported barriers included concerns regarding confidentiality, lack of trust, cultural competency of clinicians, lack of clarity about the availability and accessibility of services, and stigma within first responder organizations. Key themes influencing help-seeking were classified into six of the TDF's 14 theoretical domains: environmental context and resources; knowledge; social influences; social/professional role and identity; emotion; and beliefs about consequences. The results identified key actions that can be utilized to tailor interventions to encourage attendance at a First Responder OSI Clinic. Such approaches include providing transparency around confidentiality, policies to ensure greater cultural competency in all clinic staff, and clear descriptions of how to access care; routinely involving families; and addressing stigma.

Multilevel factors in providers' decisions to utilize CPT in military- and veteran-serving treatment settings.

Numerous guidelines exist to inform decision-making regarding psychological treatment of patients with posttraumatic stress disorder (PTSD). While strides have been made in the implementation of evidence-based psychotherapies (EBPs) for PTSD in the United States. Department of Veterans Affairs (VA), a large population of veterans does not receive such services. Research has been conducted on veterans' decisions to enroll in EBPs; however, less is known about providers' perspectives related to offering trauma-focused therapies to the military and veteran population, particularly outside the United States. This study utilizes baseline data from a larger investigation aimed to support the sustained implementation of cognitive processing therapy (CPT) in U.S. VA and Canadian Operational Stress Injury (OSI) and Department of Defense settings. Providers who trained in CPT (N = 55) participated in interviews regarding their opinions of CPT, preferred treatments for PTSD, and their process in assessing appropriate PTSD treatments for each patient. A directed content analysis approach was used to identify themes for providers' decision-making to utilize CPT within the context of four Consolidated Framework for Implementation Research (CFIR) domains. In the outer setting domain, providers reported disconnect from policy and leadership as a barrier, and in the inner setting CFIR domain, providers reported multiple facilitators: available resources, leadership support, and compatibility with CPT. The CFIR domain for characteristics of the individuals aligned with a theme of theoretical orientation and training as a facilitator. The intervention characteristics domain aligned with facilitators and barriers; complexity of CPT was a barrier, but relative advantage and perceived strength of evidence were facilitators toward implementation. The systems surrounding and supporting EBP delivery within the U.S. VA, Canada OSI, and Canadian Forces clinics have more similarities than differences regarding barriers and facilitators to delivering CPT. Despite variability in funding and training, provider experiences across all three systems suggest similar themes. Further investigation is needed to determine whether these findings extend to community samples or sites not yet offering EBPs. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Operational Stress Injury

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.

"Collapsing into Darkness": An Exploratory Qualitative Thematic Analysis of the Experience of Workplace Reintegration among Nurses with Operational Stress Injuries.

Nurses are engaged in an unpredictable and dynamic work environment where they are exposed to events that may cause or contribute to physical and/or psychological injuries. Operational stress injury (OSI) may lead to an extended time away from work or nurses leaving the profession altogether. A deliberate focus on the workplace reintegration phase of the mental health recovery process may lead to the increased retention of nurses in their profession. Prior to the creation and implementation of potential solutions to address workplace reintegration, it is imperative to explore the experiences and perceptions of nurses affected by OSI. This qualitative study aims to investigate the experiences and perceptions of nurses (N = 7) employed within a Canadian provincial healthcare system who have attempted workplace reintegration after being off of work with an OSI. Nurses were recruited via social media, unit emails, and word of mouth. Data were collected through recorded semi-structured interviews conducted over videoconferencing. Once transcribed, the data were thematically analyzed using an inductive approach. The resulting themes included (1) heroes to zeros, (2) changing the status quo, (3) connection is key, and (4) post-traumatic growth: advocacy and altruism. Study participants indicated both that nursing culture and a cumulation of events contributed to a need for a leave of absence from work and that a formalized process was desired by nurses to assist in returning to work. The development, implementation, and exploration of innovative policies, procedures, and initiatives to bridge the gap from clinical interventions to workplace reintegration are needed for nurses experiencing OSI. Further research is also needed regarding mental health impacts and appropriate resources to support nurses in their workplace reintegration process after experiencing psychological and/or physical injury.

How Do We Keep our Heads above Water? An Embedded Mixed-Methods Study Exploring Implementation of a Workplace Reintegration Program for Nurses Affected by Operational Stress Injury.

Nurses are exposed to potentially psychologically traumatic events which can lead to operational stress injuries (OSI). Workplace reintegration after an OSI can be challenging, especially with repeated exposure to potentially traumatic scenarios and workplace demands. A workplace reintegration program (RP) originally developed for police officers may be of benefit for nurses returning to work after an OSI. The purpose of this study is to investigate the perceived need for an RP for nurses, and its potential contextualization and implementation in the nursing context using an implementation science approach. This mixed-methods study collected data via questionnaires and focus groups from acute care nurses in Canada (N = 19). Data analysis was conducted using descriptive statistics, thematic analysis, and an organizational readiness assessment. Study participants indicated that formalized processes were rarely used to support nurses returning to work after time off due to mental health challenges. Themes included (1) "The Perfect Storm": the current state of return-to-work, (2) Integral Needs, and (3) A Break in the Clouds: hope for health. Exploration of innovative programs such as the RP may provide additional support to nurses affected by OSIs. Further research is needed regarding workplace reintegration for nurses, and contextualization and evaluation of the RP.

Use of the Operational Stress Injury Social Support (OSISS) Program in a Nationally Representative Sample of Canadian Active Duty Military Personnel

IntroductionRecent research evidence indicates increased mental health needs among Canadian Armed Forces (CAF) personnel. Research evidence also indicates that a portion of CAF personnel with mental health needs do not seek professional mental health care or significantly delay initiating treatment. The current study was designed to examine individual correlates of use for a paraprofessional peer support program available to CAF personnel, veterans, and their families (i.e., Operational Stress Injury Social Support [OSISS]). Methods: Participants included 6,700 CAF Regular members. Prevalence estimates were computed for all variables of interest and hierarchical logistic regression analyses served to identify correlates of OSISS use. Results: The results indicate that meeting criteria for posttraumatic stress disorder had the strongest association with OSISS use (OR = 22.31 [95% CI = 13.36-37.28]), but only a small number of CAF personnel (1.2%) seek help from OSISS. Discussion: Results suggest that OSISS use was limited and tended to occur in conjunction with professional mental health service use. Efforts could be engaged to emphasize the availability of peer support as a resource for all operational stress injuries and to increase the reach of peer support programs for military personnel.

Fear of infectious diseases and perceived contagion risk count as an occupational health and safety hazard: Accounts from correctional officer recruits in Canada

Prisons are poorly ventilated confined spaces with limited physical distancing opportunities, making an environment conducive to the spread of infectious diseases. Based on empirical research with correctional officer recruits in Canada, we analyze the reasons and sources of fear, and the measures that recruits adopt to counter their fear of contagion. Our study marks an advance in the correctional work literature, which, to date, has tended to view perceived contagion risks as a workplace challenge that can be overcome with occupational skill and experience. In contrast with the existing literature, we present fear and perceived contagion risk as an “operational stress injury” that affects all correctional officers; a structural occupational health and safety problem that needs redressing from the labor policy perspective.

Family members of Veterans with mental health problems: Seeking, finding, and accessing informal and formal supports during the military-to-civilian transition

LAY SUMMARY Veterans and their families in the military-to-civilian transition (MCT) face a multitude of changes and challenges. Family members of those Veterans experiencing a significant mental health problem (e.g., posttraumatic stress disorder, depression, anxiety) may find that navigating the MCT is made more complex, especially as they seek to find social support during this transition. The present study set out to hear from family members and learn about their obstacles and successes in accessing formal and informal support during the MCT and how this was affected by the Veteran’s mental health problems. Interviews and focus groups were completed with 36 English- and French-speaking Veteran family members across Canada. Family members shared how significant issues (e.g., mental health stigma, caregiver burden and burnout) were barriers to seeking and finding both informal (i.e., extended family, friends, online support) and formal (i.e., operational stress injury clinics, Military Family Resource Centres) support systems helpful in navigating the MCT. Despite setbacks and frustrations in accessing these supports, Veteran military families demonstrated resiliency and resolve as they pursued comfort, financial aid, respite, and counsel for themselves and for the Veteran with mental health problems during the MCT.

The diary of an operational stress injury clinic psychiatrist during the COVID-19 pandemic

The diary of an operational stress injury clinic psychiatrist during the COVID-19 pandemic

The diary of an operational stress injury clinic psychiatrist during the COVID-19 pandemic

The diary of an operational stress injury clinic psychiatrist during the COVID-19 pandemic

The diary of an Operational Stress Injury clinic psychiatrist during the COVID-19 pandemic

The diary of an Operational Stress Injury clinic psychiatrist during the COVID-19 pandemic

Improving psychiatric–psychological assessment capacity by matching level of care to client outcomes: enhancing discharge planning at an operational stress injury clinic in Canada

Mental health centres that assess and treat Canadian Forces members and Veterans have been experiencing an increasing number of referrals. At an Operational Stress Injury Clinic located in London, Ontario, which is mandated to treat this population, approximately half of clients are discharged within a year and another 12.1% require treatment for 5–9 years. The increasing complexities, such as multiple comorbidities, of these long-term clients reduce clinics’ ability to rapidly assess and treat new clients. This article explores the decision point of whether to continue treatment or to discharge a client to a different level of care as well as how best to provide treatment while keeping care transitions in mind. Enhancing the discharge process could lead to a greater capacity for treating new referrals.

Adverse combat experiences, feeling responsible for death, and suicidal ideation in treatment-seeking Veterans and actively serving Canadian Armed Forces members

Introduction: The present study examines the relationship between feeling responsible for the death of another and suicidal ideation (SI) while controlling for post-traumatic stress disorder (PTSD), major depressive disorder (MDD), and general adverse deployment experiences. Methods: Participants were current and former Canadian Armed Forces personnel ( N=276) seeking treatment at a hospital-based operational stress injury clinic. Data was collected as part of a standard intake protocol. Results: Although 43.5% of the sample reported feeling responsible for the death of another in at least one instance, this variable did not emerge as a significant predictor of SI. Instead, MDD and PTSD severity were the only significant predictors of SI in our model. Discussion: Consistent with previous research, MDD emerged as the strongest predictor of SI. Results emphasize the influence of psychiatric conditions on suicidal behaviour over and above other combat-related variables.

System-Wide Implementation of Routine Outcome Monitoring and Measurement Feedback System in a National Network of Operational Stress Injury Clinics.

This manuscript reviews the development and implementation process of the Client Reported Outcome Monitoring Information System in the VA Canada Operational Stress Injury National Network, and reports on outcomes of an evaluation to assess usage, barriers, and facilitators to implementation. The majority of clinicians reported regular use of routine outcomes monitoring, although objective data suggested somewhat lower actual use. In general, clinicians endorsed all barriers and most facilitators as influencing their use of routine outcomes monitoring in a minor way. However, users and non-users differed in their endorsement of facilitators and barriers. Implications for research and implementation efforts are discussed.

The Impact of Parental Operational Stress Injury on Child Mental Health and Well-Being: A Scoping Review

ABSTRACTRecognizing the impact of parental mental health on child development, the purpose of this scoping review was to identify and synthesize the research literature describing the impact of parental operational stress injury (OSI) on children and youth from military and veteran families. Arksey and O'Malley's 2005 guidelines for conducting scoping reviews were followed. A total of 18 separate databases were searched, in addition to three university-based discovery platforms. From this search, 506 potential sources were identified; 64 proceeded to full data extraction and analysis. This study identified two significant themes in the current literature. First, there are multiple ways in which parental OSIs can impact children and youth. Families need to renegotiate parenting roles and responsibilities, experience changes in spousal relationships that can cascade into parenting, and face shifting family dynamics. In addition, children and youth can experience secondary traumatization, be at risk for child maltreatment, and manifest general impacts on their mental health and development. Second, responding to the impacts through collaboration and innovation. Future directions include informing research with the voices of all members of the family. Knowledge translation strategies are necessary for collaboration across all areas to support this population.

Sexual Functioning Among a Cohort of Treatment-Seeking Canadian Military Personnel and Veterans With Psychiatric Conditions.

The aim of this study was to assess potential predictors of sexual dysfunction and dissatisfaction in a sample of 99 current and former Canadian Forces members attending the Parkwood Hospital Operational Stress Injury Clinic for mental health treatment. Respondents completed a number of questionnaires assessing sexual functioning, post-traumatic stress disorder symptom severity, health-related quality of life, and self-perceived masculinity traits. Regression analyses revealed that role limitations because of physical problems predicted erectile functioning (β = 0.107, p = 0.075), whereas vitality predicted orgasmic functioning (β = 0.044, p = 0.032). Hypermasculinity was the strongest predictor of sexual desire (β = 0.466, p = 0.036), and sexual satisfaction was significantly predicted by bodily pain (β = 0.036, p = 0.019). Preliminary analyses revealed a significant mediating effect of bodily pain on the relationship between post-traumatic stress disorder symptom severity. Results suggest a nuanced interplay between physical health and mental health factors regarding sexual functioning in treatment-seeking military personnel and veterans; however, further research is needed to better delineate the relationship between the 2.