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. 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. 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. 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. 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.
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. During the First World War era, psychological symptoms suffered by soldiers in war came to be referred to as "shell shock". This progressed by the Second World War to being called "battle fatigue", or "combat stress reaction". 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. 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. 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. 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. 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. 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. As of late 2016, the Parliament of Canada is exploring a national strategy to address OSIs within the various public safety professions. 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. 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. The same psychiatric conditions are the subject of considerable study and public policy discussion among the first responder professions. Two or more of these diagnoses may be comorbid, and comorbidity may also exist with physical injuries or illnesses.
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. 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.
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.
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