Operational stress injury

Last updated

Operational stress injury or OSI is a non-clinical, non-medical term referring to a persistent psychological difficulty caused by traumatic experiences or prolonged high stress or fatigue during service as a military member or first responder. [1] [2] The term does not replace any individual diagnoses or disorders, but rather describes a category of mental health concerns linked to the particular challenges that these military members or first responders encounter in their service. There is not yet a single fixed definition. The term was first conceptualized within the Canadian Armed Forces to help foster understanding of the broader mental health challenges faced by military members who have been impacted by traumatic experiences and who face difficulty as a result. [2] OSI encompasses a number of the diagnoses found in the Diagnostic and Statistical Manual of Mental Disorders (DSM) classification system, with the common thread being a linkage to the operational experiences of the afflicted. [3] The term has gained traction outside of the military community as an appropriate way to describe similar challenges suffered by those whose work regularly exposes them to trauma, particularly front line emergency first responders such as but not limited to police, firefighters, paramedics, correctional officers, and emergency dispatchers. [4] The term, at present mostly used within Canada, is increasingly significant in the development of legislation, policy, treatments and benefits in the military and first responder communities. [4]

Contents

History

Military members experiencing wartime trauma may suffer debilitating psychological effects from their experiences, and historical research has found literary references to these psychological packs throughout recorded history. [5] During the First World War era, psychological symptoms suffered by soldiers in war came to be referred to as "shell shock". [5] This progressed by the Second World War to being called "battle fatigue", or "combat stress reaction". [5] As research continued and the understanding of psychology and psychiatry advanced, it gradually became more understood through the 20th century that experiencing trauma could have a variety of psychological and emotional impacts that were genuinely medical in nature. [5] Increasingly, research focused on developing clinical definitions and exploring options for treatments and therapies. The term 'posttraumatic stress disorder' (PTSD), was developed for inclusion in the DSM-III in the 1980s. [6] While not a condition limited to those who had experienced wartime trauma, PTSD is often associated with soldiers returning from wartime.

In 2001, Canadian Forces Lieutenant Colonel Stéphane Grenier coined the term 'Operational stress injury' to describe a mental or emotional injury suffered by soldiers in the course of their service. [7] The term was designed to expand the understanding of mental health disorders related to service beyond just PTSD, and to include other clinical diagnoses linked to trauma. The word 'injury' was chosen to help shift the view of these disorders in order to extend to them the same legitimacy in discourse as physical injuries, and to help reduce the stigma surrounding mental health. [2] Not a diagnosis itself, operational stress injury was described by the Canadian Forces as a “grouping of diagnoses that are related to injuries that occur as part of operations", most commonly PTSD, major depression, and generalized anxiety. [8]

By 2016, the Canadian Parliamentary Standing Committee on Public Safety and National Security recognized OSIs as an issue faced by all first responder organizations, not just the military. [4] As of late 2016, the Parliament of Canada is exploring a national strategy to address OSIs within the various public safety professions. [4] The term does not as of yet have any regular use outside of Canada.

Commonly included diagnoses

The concept of operational stress injury is still emerging and evolving, and does not as of yet have a commonly accepted fixed definition. [2] [4] Research within the Canadian military has nonetheless identified several disorders most commonly associated with traumatic service-related experiences, and which have generally been accepted as included in the term. [9] The same psychiatric conditions are the subject of considerable study and public policy discussion among the first responder professions. [10] Two or more of these diagnoses may be comorbid, and comorbidity may also exist with physical injuries or illnesses. [11]

Posttraumatic stress disorder

Posttraumatic stress disorder, or PTSD, is among the most common individual diagnoses linked to traumatic exposure in military or first responder service. [12] [10] PTSD is related to anxiety disorders, and is linked to the intrusive and unwanted re-experiencing of traumatic events. Those suffering from PTSD will often seek to avoid and may be triggered by stimuli that cause recollection of their traumatic exposures. Symptoms may include inability to sleep, anger, irritability, fear, hypervigilance, and hyperarousal. A study of over 30,000 Canadian soldiers following deployments to Afghanistan and the former Yugoslavia found 8.9% of the study cohort to be suffering from PTSD after an average follow-up period of nearly four years. [9]

Depression

Depression refers, generally, to major depressive disorder or related mood disorders. Depression is widely believed to be the most prevalent mental health diagnosis faced by military members and first responders, accounting for a significant portion of those who are unable to work fully or at all due to mental health reasons. Research within the Canadian Armed Forces has found that at least 8% of full-time members of the Canadian Military exhibit symptoms of major depression. [13]

Anxiety disorders

Anxiety disorders, including general anxiety disorder, acute stress disorder, social anxiety disorder, and other related diagnoses are also frequently found in the military and first response community. [12] While PTSD falls under the larger category of anxiety disorders, it is often considered distinctly due to its greater prevalence than other anxiety disorders. Anxiety disorders frequently manifest in the form of debilitating stress and anxiety experienced by a victim in the presence or anticipation of triggering stimuli. Anxiety may be disabling in that it may render someone incapable of coping well or at all with a situation that would normally be within their capabilities absent the clinical anxiety. Military research has found anxiety disorders to be more prevalent in those who had deployed to active conflicts. [13] When PTSD is totalled with other anxiety disorders, this category of mental health diagnosis is the most prevalent among Canadian military personnel with deployments [9]

Adjustment disorder

A lesser known but not uncommon diagnosis among military personnel, [9] adjustment disorder (sometimes referred to as situational depression) is characterized by an individual's inability to adjust to external stressors, or major life events. Although presentation will vary, it may include a combination of depressive, anxious, or post-traumatic stress symptoms that do not meet the clinical threshold for those related named disorders. Adjustment disorder often abates once a person is able to adapt to new circumstances. Military members and first responders may potentially face significant life changes in their careers, including geographic relocations, exposure to very different cultural norms, and potentially the life changing impact of injury or illness and the inability to continue with their career.

Substance-related disorder, or the abuse of alcohol or drugs, may also be included in the operational stress injury umbrella. [1] The various psychological effects of different substances, particularly the depressive effects of excess alcohol consumption, often serve as a form of 'self medication' for those dealing with other stressors or traumas. Alcohol or drug addictions can often mask or complicate the treatment of symptoms of other disorders, and may need to be addressed before treatment for underlying disorders can be effective. [14]

Suicide

There is a well established link between operational stress injury symptoms, and a heightened risk of suicide. [15] While suicide and suicidality data for military and public safety professions is not comprehensive, these professions are not exceptions to established links between the various mental health disorders and a greater risk of death by suicide.

Treatment

The various disorders that are broadly called 'operational stress injuries' each have their own bodies of research into various treatments and therapies. Most treatments can either be considered pharmacological, such as antidepressant or antianxiety medication, or psychosocial therapy, such as cognitive behavioural therapy. For many patients a combined approach is used, [1] with medications helping to stabilize moods and symptoms while behavioural therapy helps to address underlying memories, cognitions, situation appraisals, and other thinking patterns.

The military and public safety professions vary widely among differing jurisdictions as to what is available in terms of therapy. Military members in western nations typically are covered to some extent by their respective military health services, or by governmental departments dedicated to providing services to veterans, such as Veterans Affairs Canada or the United States Department of Veterans Affairs. Police, firefighters, paramedics, and other related professions will each have differing health care arrangements and benefits depending on the health services an insurance arrangements in their respective country, state, province, territory, or municipality.

In addition to formal healthcare settings, numerous grassroots or state-funded peer support organizations have emerged. Many of these organizations help affected veterans or first responders to connect with each other in physical or virtual peer support settings. [16] Increasingly these organizations have played a role in crisis intervention, suicide prevention, and ongoing support. While informal peer support efforts do not substitute for proper clinical care, they help some affected personnel to begin accepting that they are suffering from traumatic or other stress linked to their occupations, and to begin accessing clinical resources.

Related Research Articles

Post-traumatic stress disorder Mental disorder that can develop after exposure to a traumatic event

Post-traumatic stress disorder (PTSD) is a mental and behavioral disorder that can develop because of exposure to a traumatic event, such as sexual assault, warfare, traffic collisions, child abuse, domestic violence or other threats on a person's life. Symptoms may include disturbing thoughts, feelings, or dreams related to the events, mental or physical distress to trauma-related cues, attempts to avoid trauma-related cues, alterations in the way a person thinks and feels, and an increase in the fight-or-flight response. These symptoms last for more than a month after the event. Young children are less likely to show distress, but instead may express their memories through play. A person with PTSD is at a higher risk of suicide and intentional self-harm.

Psychological trauma is damage to a person's mind as a result of one or more events that cause overwhelming amounts of stress that exceed the person's ability to cope or integrate the emotions involved, eventually leading to serious, long-term negative consequences. Trauma is not the same as mental distress or suffering, both of which are universal human experiences.

Eye movement desensitization and reprocessing (EMDR) is a form of psychotherapy in which the person being treated is asked to recall distressing images; the therapist then directs the patient in one type of bilateral stimulation, such as side-to-side eye rapid movement or hand tapping. EMDR was developed by Francine Shapiro starting in 1988. According to the 2013 World Health Organization (WHO) practice guideline: "This therapy [EMDR] is based on the idea that negative thoughts, feelings and behaviours are the result of unprocessed memories. The treatment involves standardized procedures that include focusing simultaneously on (a) spontaneous associations of traumatic images, thoughts, emotions and bodily sensations and (b) bilateral stimulation that is most commonly in the form of repeated eye movements."

Acute stress disorder is a psychological response to a terrifying, traumatic, or surprising experience. Acute stress disorder is not fatal, but it may bring about delayed stress reactions if not correctly addressed.

Complex post-traumatic stress disorder is a psychological disorder that can develop in response to prolonged, repeated experience of interpersonal trauma in a context in which the individual has little or no chance of escape. C-PTSD relates to the trauma model of mental disorders and is associated with chronic sexual, psychological, and physical abuse or neglect, or chronic intimate partner violence, victims of kidnapping and hostage situations, indentured servants, victims of slavery and human trafficking, sweatshop workers, prisoners of war, concentration camp survivors, residential school survivors, and prisoners kept in solitary confinement for a long period of time. It is most often directed at children and emotionally vulnerable adults, and whilst motivations behind such abuse vary, though mostly being predominantly malicious, it has also been shown that the motivations behind such abuse can be well-intentioned. Situations involving captivity/entrapment can lead to C-PTSD-like symptoms, which can include prolonged feelings of terror, worthlessness, helplessness, and deformation of one's identity and sense of self.

Peer support occurs when people provide knowledge, experience, emotional, social or practical help to each other. It commonly refers to an initiative consisting of trained supporters, and can take a number of forms such as peer mentoring, reflective listening, or counseling. Peer support is also used to refer to initiatives where colleagues, members of self-help organizations and others meet, in person or online, as equals to give each other connection and support on a reciprocal basis.

Childhood trauma is often described as serious adverse childhood experiences (ACEs). Children may go through a range of experiences that classify as psychological trauma, these might include neglect, abandonment, sexual abuse, and physical abuse, witnessing abuse of a sibling or parent, or having a mentally ill parent. These events have profound psychological, physiological, and sociological impacts and can have negative, lasting effects on health and well-being such as unsocial behaviors, attention deficit hyperactivity disorder (ADHD), and sleep disturbances. Similarly, children with mothers who have experienced traumatic or stressful events during pregnancy can increase the child's risk of mental health disorders and other neurodevelopmental disorders. Kaiser Permanente and the Centers for Disease Control and Prevention's 1998 study on adverse childhood experiences determined that traumatic experiences during childhood are a root cause of many social, emotional, and cognitive impairments that lead to increased risk of unhealthy self-destructive behaviors, risk of violence or re-victimization, chronic health conditions, low life potential and premature mortality. As the number of adverse experiences increases, the risk of problems from childhood through adulthood also rises. Nearly 30 years of study following the initial study has confirmed this. Many states, health providers, and other groups now routinely screen parents and children for ACEs.

Traumatic stress is a common term for reactive anxiety and depression, although it is not a medical term and is not included in the Diagnostic and Statistical Manual of Mental Disorders (DSM). The experience of traumatic stress include subtypes of anxiety, depression and disturbance of conduct along with combinations of these symptoms. This may result from events that are less threatening and distressing than those that lead to post-traumatic stress disorder. The fifth edition of the DSM describes in a section titled "Trauma and Stress-Related Disorders" disinhibited social engagement disorder, reactive attachment disorder, acute stress disorder, adjustment disorder, and post-traumatic stress disorder.

Prolonged exposure therapy (PE) is a form of behavior therapy and cognitive behavioral therapy designed to treat post-traumatic stress disorder. It is characterized by two main treatment procedures – imaginal and in vivo exposures. Imaginal exposure is repeated 'on-purpose' retelling of the trauma memory. In vivo exposure is gradually confronting situations, places, and things that are reminders of the trauma or feel dangerous. Additional procedures include processing of the trauma memory and breathing retraining.

As defined by the United States Department of Veterans Affairs, military sexual trauma (MST) are experiences of sexual assault, or repeated threatening sexual harassment that occurred while a person was in the United States Armed Forces.

Memory is described by psychology as the ability of an organism to store, retain, and subsequently retrieve information. When an individual experiences a traumatic event, whether physical or psychological, their memory can be affected in many ways. For example, trauma might affect their memory for that event, memory of previous or subsequent events, or thoughts in general. Additionally, It has been observed that memory records from traumatic events are more fragmented and disorganized than recall from non traumatic events. Comparison between narrative of events directly after a traumatic event versus after treatment indicate memories can be processed and organized and that this change is associated with decrease in anxiety related symptoms.

Veterans benefits for post-traumatic stress disorder in the United States United States Department of Veteran Affairs disability support for post-traumatic stress disorder

The United States has compensated military veterans for service-related injuries since the Revolutionary War, with the current indemnity model established near the end of World War I. The Department of Veterans Affairs (VA) began to provide disability benefits for post-traumatic stress disorder (PTSD) in the 1980s after the diagnosis became part of official psychiatric nosology.

PTSD is a psychiatric disorder characterized by intrusive thoughts and memories, dreams, or flashbacks of the event; avoidance of people, places, and activities that remind the individual of the event; ongoing negative beliefs about oneself or the world, mood changes, and persistent feelings of anger, guilt, or fear; alterations in arousal such as increased irritability, angry outbursts, being hypervigilant, or having difficulty with concentration and sleep. PTSD is commonly treated with various types of psychotherapy and pharmacotherapy.

Lieutenant Colonel (Retired) Stéphane Grenier is a French-Canadian military officer known for his work on psychological war trauma and posttraumatic stress disorder. Grenier developed the term Operational Stress Injury (OSI) to describe psychological injuries caused by military duty.

Moral injury refers to an injury to an individual's moral conscience and values resulting from an act of perceived moral transgression, which produces profound emotional guilt and shame, and in some cases also a sense of betrayal, anger and profound "moral disorientation".

The Clinically Administered PTSD Scale (CAPS) is an in-person clinical assessment for measuring posttraumatic stress disorder (PTSD). The CAPS includes 30 items administered by a trained clinician to assess PTSD symptoms, including their frequency and severity. The CAPS distinguishes itself from other PTSD assessments in that it can also assess for current or past diagnoses of PTSD.

Trauma and first responders

The nature of a first responder's occupation continuously puts them in harm's way as well as regularly expose them to others who have been injured or harmed. First responders are normally the first people on the scene and experience difficult situations. They are the first to help survivors and give emotional assistance to people caught in a trauma situation. The responsibilities that first responders have are very important but over time have put their well being and overall health at risk. Trauma is the emotional shock that follows a very stressful event or a physical injury. These occupations subject individuals to a great deal of traumatic events, resulting in a higher risk of developing post-traumatic stress disorder (PTSD), major depressive disorder (MDD), panic disorder (PD), and generalized anxiety disorder (GAD). Exposure to multiple traumatic stressors could also exacerbate other pre-existing conditions. The presence of any mental health disorders in these individuals can also be associated with diminished ability to work efficiently, early retirement, substance abuse, and suicide. The term First responders was written in The U.S. Homeland Security Presidential Directive, HSPD-8, defines "The term "first responder" refers to those individuals who in the early stages of an incident are responsible for the protection and preservation of life, property evidence, and the environment, including emergency response providers" The term first responder can refer to Law enforcement, Firefighters, EMT's, Paramedics, Dispatchers, and soldiers.

Post Traumatic Stress Disorder after World War II

Post-Traumatic Stress Disorder (PTSD) results after experiencing or witnessing a terrifying event which later leads to mental health problems. This disorder has always existed but has only been recognized as a psychological disorder within the past forty years. Before receiving its official diagnosis in 1980, when it was published in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-lll), Post-Traumatic Stress Disorder was more commonly known as Soldier’s Heart, Irritable Heart, or Shell Shock. “Shell Shock” and “War Neuroses” were coined during World War I when symptoms began to be more commonly recognized among many of the soldiers that had experienced similar traumas. By World War II, these symptoms were identified as “Combat Stress Reaction” or “Battle Fatigue”. In the first edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-I), Post Traumatic Stress Disorder was called “Gross Stress Reaction” which was explained as prolonged stress due to a traumatic event. Upon further study of this disorder in World War II veterans, psychologists realized that their symptoms were long-lasting and went beyond an anxiety disorder. Thus, through the effects of World War II, Post Traumatic Stress Disorder was eventually recognized as an official disorder in 1980.

Cannabis use and trauma is the contribution that trauma plays in promoting the use and potential abuse of cannabis. Conversely, cannabis use has been associated with the intensity of trauma and PTSD symptoms. While evidence of efficacious use of cannabis is growing in novelty, it is not currently recommended.

Trauma and post-traumatic stress disorder (PTSD) in Asian Americans is a growing topic related to trauma and racial psychology that requires more attention and research.

References

  1. 1 2 3 "Operational Stress Injuries and PTSD - The Royal". Theroyal.ca. Retrieved 2017-03-14.
  2. 1 2 3 4 "INTERIM REPORT ON THE OPERATIONAL STRESS INJURIES OF CANADA'S VETERANS" (PDF). Parl.gc.ca. Retrieved 2017-03-14.
  3. ↑ "Understanding Mental Health". veterans.gc.ca. Veterans Affairs Canada. 2016-02-12. Retrieved 2017-03-14.
  4. 1 2 3 4 5 "HEALTHY MINDS, SAFE COMMUNITIES : SUPPORTING OUR PUBLIC SAFETY OFFICERS THROUGH A NATIONAL STRATEGY FOR OPERATIONAL STRESS INJURIES" (PDF). Parl.gc.ca. Retrieved 2017-03-14.
  5. 1 2 3 4 Friedman, Matthew (2015-08-13). "History of PTSD in Veterans: Civil War to DSM-5". ptsd.va.gov. US Department of Veterans Affairs. Retrieved 2017-03-14.
  6. ↑ "Caring for veterans with PTSD". Clinicaladvisor.com\accessdate=2017-03-14. 2015-11-11.
  7. ↑ "Stéphane Grenier | Speaker | National Speakers Bureau". Nsb.com. 2015-11-26. Retrieved 2017-03-14.
  8. ↑ "Surgeon General's Mental Health Strategy : Canadian Forces Health Services Group" (PDF). Forces.gc.ca. Retrieved 2017-03-14.
  9. 1 2 3 4 Boulos, David; Zamorski, Mark A. (6 August 2013). "Deployment-related mental disorders among Canadian Forces personnel deployed in support of the mission in Afghanistan, 2001–2008". CMAJ. 185 (11): E545–E552. doi:10.1503/cmaj.122120. PMC   3735772 . PMID   23820441.
  10. 1 2 "House of Commons Committees - SECU (42-1) - Healthy Minds, Safe Communities: Supporting our Public Safety Officers through a National Strategy for Operational Stress Injuries - STUDY ON OPERATIONAL STRESS INJURIES AND POST-TRAUMATIC STRESS DISORDER IN PUBLIC SAFETY OFFICERS AND FIRST RESPONDERS". Parl.gc.ca. Retrieved 2017-03-14.
  11. ↑ "Evaluation of the Operational Stress Injury (OSI) Clinic Network - October 2008 - Departmental Audit and Evaluation Reports - Veterans Affairs Canada". Veterans.gc.ca. Retrieved 2017-03-14.
  12. 1 2 Pickett, Treven; Rothman, David; Crawford, Eric F.; Brancu, Mira; Fairbank, John A.; Kudler, Harold S. (1 November 2015). "Mental Health Among Military Personnel and Veterans". North Carolina Medical Journal. 76 (5): 299–306. doi: 10.18043/ncm.76.5.299 . PMID   26946859.
  13. 1 2 "Mental health of the Canadian Armed Forces". Statcan.gc.ca. 2015-11-27. Retrieved 2017-03-14.
  14. ↑ "Policy Document - Veterans Affairs Canada". Veterans.gc.ca. Retrieved 2017-03-14.
  15. ↑ "Current Issues in Mental Health in Canada: Mental Health in the Canadian Forces and Among Veterans". Parliament of Canada. Retrieved 2017-03-14.
  16. ↑ "Afghanistan war veterans turn to social media for community and solace". The Globe and Mail . Retrieved 2017-03-14.
This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.