Primary Prevention

Understanding Operational Stress Injuries & Post-Traumatic Stress Disorder

An Operational Stress Injury (OSI) is any persistent psychological difficulty resulting from operational duties. Workers experiencing high levels of operational stress injury are at greater risk of suffering from depression, anxiety or post-traumatic stress disorder (Canadian Mental Health Association, 2019).

Post-Traumatic Stress Disorder, also referred to as PTSD, is one type of operational stress injury. It is a mental illness that results from exposure to trauma from single or multiple events that involve death or the threat of death or serious injury. PTSD may also be linked to ongoing emotional trauma, such as abuse in a relationship (Canadian Mental Health Association).

What is Trauma?

According to the Centre for Addition and Mental Health (CAMH), trauma is “a term used to describe the challenging emotional consequences that living through a distressing event can have for an individual.” Each person can experience trauma differently and what might be traumatic for one person, may not be as traumatic for someone else.  The Workplace Safety and Insurance Board (WSIB) outlines some examples of trauma:

• Witnessing a fatality or horrific accident.
• A traumatic event that occurred in the past (e.g. sexual assault, death of a spouse or child, living through a natural disaster).
• Witnessing or being the object of an armed robbery.
• Witnessing or being the object of a hostage taking.
• Being the object of physical violence.
• Being the object of death threats or threats of physical violence.
• Workplace harassment that includes physical violence, life threatening or potentially life threatening situations (e.g. tampering with safety equipment).

Causes of PTSD and Risk Factors

PTSD is caused by a complex mix of:

• Life experiences, including the amount of and severity of trauma experienced since early childhood.
• The way the brain regulates and releases chemicals and hormones in response to stress.
• Genetically inherited mental health risks, such as an increased risk of anxiety or depression and aspects of personality or temperament.

Several factors can impact whether a worker develops PTSD as a result of their job or situations that occur in their workplace, such as:

• A job that increases the risk of being exposed to traumatic events (e.g. frontline healthcare workers, first responders, corrections and military personnel).
• Experiencing intense or long-lasting trauma.
• Seeing people get killed or hurt.
• Having experienced other trauma earlier in life, including childhood abuse and or neglect.
• Having other mental health problems, such as anxiety or depression.
• Lacking a good support system of family and friends.
• Dealing with extra stress after the event, such as loss of a loved one, pain and injury, or loss of a job or home.
• Having biological relatives with mental health problems, including PTSD or depression.

Signs & Symptoms

PTSD symptoms often start within one month of an event or repeated events. In some cases, symptoms may not appear until months or years later. Symptoms can make it hard for a worker to function at work and in their everyday life. PTSD can increase the risk of other mental health problems, such as depression and anxiety, substance abuse and suicidal thoughts and behaviours.

There are three types of symptoms associated with PTSD:

1. Intrusive Memories

Intrusive memories, also known as re-experiencing symptoms, can begin from your thoughts or be triggered by words, objects or situations that are reminders of the traumatic event. Intrusive memories include:

• Recurring, unwanted distressing memories of the traumatic event.
• Reliving the event as if it were happening again.
• Upsetting dreams about the event.
• Severe emotional distress or physical reactions to a reminder of the event (e.g. heart racing, hands sweating).

2. Avoidance

Avoidance symptoms may cause a worker to change their routine, including avoiding things that remind them of the event as well as negative changes in thinking and mood. Avoidance symptoms include:

• Trying to avoid thinking about the event.
• Avoiding places, objects, activities or people that are reminders of the event.
• Increased negative feelings about oneself or others.
• Feeling emotionally numb or unable to experience positive or negative emotions.
• Feeling hopeless about the future.
• Losing interest in activities that were enjoyable in the past.
• Feeling intense guilt, depression or worry.
• Memory problems, including not remembering important aspects of the traumatic event.
• Difficulty maintaining close relationships.

3. Hyper-Arousal Symptoms

Hyper-arousal symptoms are changes in emotional reactions that can make you feel stressed, angry, and overwhelmed. They are usually constant. Symptoms include:

• Irritability, feeling tense or “on guard”.
• Difficulty sleeping.
• Angry outbursts or aggressive behaviours.
• Feelings of overwhelming guilt or shame.
• Self-destructive behaviours.
• Trouble concentrating or sleeping.
• Being easily startled or frightened.

Workers’ Roles & Responsibilities for Establishing Positive Workplace Mental Health

Under the Occupational Health and Safety Act (OHSA), all workplace parties have responsibilities when it comes to workplace hazards, including psychosocial hazards. The law requires all workers to:

• Comply with the OHSA and its regulations.
• Comply with workplace policies and procedures.
• Use and wear the personal protective equipment, protective devices or clothing required by their employer.
• Report actual or potential hazards to your supervisor.
• Participate in training and education about OSI/PTSD, mental health literacy and other programs identified by your employer.

Additionally, to support positive mental health, you can:

• Listen to co-workers and encourage engagement in mental health programing.
• Reduce stigma by participating in positive conversations.

For more on roles responsibilities for Employers, Supervisors and Joint Health and Safety Committees, and how these parties can take action to prevent occupational stress injuries, see Primary Prevention recommendations for Employers & Supervisors.

Building Resiliency

Having resilience or taking resilience training is often identified as a way to prevent the impact of mental injuries or exposures to trauma. A common definition of resilience is the ability of a person or organization to successfully adapt and recover after stress, adversity or trauma. Another definition is “In the context of exposure to significant adversity, resilience is both the capacity of individuals to navigate their way to the psychological, social, cultural, and physical resources that sustain their well-being, and their capacity individually and collectively to negotiate for these resources to be provided in culturally meaningful ways" (Ungar, 2008).

Being resilient is more than just having a positive attitude and being able to “bounce back”. Several factors support and contribute to an individual’s resilience, including:

• Having a safe and supportive environment.
• Understanding what resources, services and supports are available to us in our community, our workplace and within ourselves, and the ability to access these to support our physical health and mental wellbeing.
• The ability to implement healthy behaviours.
• Building and supporting relationships that you feel you can count on – family, friends and coworkers.
• Fostering a sense of belonging to your community – be it religious, spiritual, cultural or otherwise.
• Selfefficacy; the belief in one’s ability to achieve certain outcomes in life, or to be in control of one’s life.
• The ability to maintain structure and routines.
• Understanding how to improve and access supports to improve our financial wellbeing.

Make sure that you ask about the resources provided through your organization and ensure that you have a good understanding of how to find and access these supports when you need them. Take time to create your own resilience plan. This may include:

• Listing what services and supports exist in your workplace and how you can access them.
• Calling your Employee Assistance Program (EAP) to learn more about how they can support you in all aspects of your life. This may include financial wellbeing, health and wellness, nutrition, balancing life and work and family commitments.
• Accessing free resources like www.pshsa.ca/healthyworkers to help learn tips and tricks you can employ on your quest for health and wellness.
• Talking to your family doctor about your physical and mental wellbeing, including stressors in your life.
• Making a plan about how you will implement selfcare.
• The steps you will take to seek help. These may include talking to your intimate partner, friends or family about what is happening in your life.
• Talking to your financial advisor on how to improve your financial wellbeing.
• Making a list of routine activities that are a normal part of your life which you are responsible for and will help you maintain structure and expectation.

Dr. Michael Ungar, a researcher from Dalhousie University, and his team have developed an Adult Resilience Measure (ARM-R) which is a self-report measure of social-ecological resilience.  To learn more about the social ecology of resilience, visit our Research page.