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Laura Niemi, Ph.D.


Why Calling Stress an Injury Matters

Language which conveys that recovery is possible helps fight stigma.

Source: L. Niemi
Natalie Boychuk, research assistant in the Applied Moral Psychology Lab at the University of Toronto, at Columbia University's MPH program Fall 2019.
Source: L. Niemi

Guest Blogger Natalie Boychuk writes on recent research with the Ontario government on operational stress injury. She reflects on how language used in the context of mental health care should meet the needs of people facing intense stress and help fight stigma about getting help.

In recent research (Niemi, L., Leone, C., Boychuk, N., Hadjis, Z., Roussos, G., Warchol, M., You, L., 2019) on operational stress injury (OSI) in Ontario, the Applied Moral Psychology Lab at the Munk School of Global Affairs & Public Policy at the University of Toronto studied the intense stressors faced by first responders on the job. Occupational stressors can be broadly defined in terms of three sources: critical incidents, daily hassles, and relational stressors, all of which tend to affect first responders at rates higher than the general population (CMHA, 2019). Carleton (2017) found that stressors have clinically relevant consequences for many Canadian responders, including municipal, provincial, and national police officers, firefighters, correctional officers, and paramedics: Between 17 percent and 24 percent reported significant PTSD symptoms over the last month.

Critical incidents refer to direct trauma faced while on duty, while daily hassles refer to organizational challenges, including long shifts and strict institutional hierarchies. Additionally, relational stressors involve managing relationships within the larger community, with other first responders, and with family and loved ones.

Source: Flickr

The literature on operational stress in first responders actually suggests that across occupations, the daily hassles of working within the constraints of bureaucracies with strict hierarchies contributes more to stress injury than acute traumatic incidents (Larsson, 2016). This implies that mental health treatment must be consistently accessible to people throughout the organization in order to manage chronic institutional stressors.

Unfortunately, stigma is a significant factor in determining whether or not distressed people obtain access to mental health services. Corrigan (2004) found that less than 30 percent of people with mental disorders seek treatment, meaning that even though we have made great strides in improving the quality of mental health services, most people choose not to use them. A 2009 Ontario Health Survey found that half of the respondents would be embarrassed for their friends or family to discover they were seeking mental health treatment (Jagdeo, Stein, Cox & Sareen, 2009).

Stigma is exacerbated in first responder occupations, possibly because they tend to be male-dominated or less likely to acknowledge the need for their own personal assistance (Clement et al., 2015). The characteristically close relationships that tend to form among first responders also inadvertently contribute to the stigma that many feel when seeking mental health care. For instance, given the tight-knit nature of firefighting, external mental health professionals may be perceived as “outsiders” who cannot be trusted (Henderson et al., 2016). Many first responders may find it prohibitively difficult to seek out mental health treatment—one police officer described taking time off for mental health treatment as “career suicide” (Stuart, 2017).

Sue Ogrocki, 2013 AP
Source: Sue Ogrocki, 2013 AP

In our research, we found that language matters in reducing this stigma. The recent use of injury, rather than disorder terminology around post-traumatic stress seems to play an important role in treating trauma and other work-related stress conditions by implying that they are impermanent and treatable. Furthermore, injury suggests a higher degree of personal control over the distress and emphasizes a recovery endpoint, which can mitigate people’s feelings of helplessness.

Given the positive impacts of using injury (rather than disorder) terminology to describe work-related chronic stress, the Global PTSI Foundation was formed in 2009 in order to demonstrate their goal that post-traumatic stress be considered a treatable and impermanent condition. While the use of injury-focused language has the benefit of increasing the accessibility of treatment for those who need it, it also has the potential to create confusion in research circles and be intractable in policy. However, its creation and effective adoption demonstrate the need and demand for destigmatizing language that facilitates access to effective mental health interventions for more people. Ultimately, first responders and other high-risk groups are the primary evaluators of mental health interventions, and the nomenclature should reflect their needs.

“It’s OK to get professional help. You can be cured and go back to being an effective firefighter.” (Galante, 2017).

Facebook/LinkedIn Image Credit: gpointstudio/Shutterstock


Niemi, L., Leone, C., Boychuk, N., Hadjis, Z., Roussos, G., Warchol, M., You, L. (2019). Extraordinary duties, extraordinary stressors: Assessing the need and potential for innovative approaches to first responders’ stress injuries. White paper.

Carleton, R.N., Afifi, T.O., Turner, S. et al (2017). Mental disorder symptoms among public safety personnel in Canada. Canadian Journal of Psychiatry, 63(1): 54-64.

Clement S, Schauman O, Graham T, Maggioni F, Evans-Lacko S, Bezborodovs N, et al. (2015). What is the impact of mental health-related stigma on help-seeking? A systematic review of quantitative and qualitative studies. Psychological Medicine, 45(1), 11–27.

Corrigan, P. (2004). How stigma interferes with mental health care. American psychologist, 59(7), 614.

Galante, A. (2017). Las Vegas first responders deal with emotional aftermath of mass shooting. NBC News. Retrieved at:…

Henderson, S. H., Van Hasselt, V. C., LeDuc, T. J., Couwels, J. (2016). Firefighter suicide: Understanding cultural challenges for mental health professionals. Professional Psychology: Research and Practice, 47(3), 224-230.

Jagdeo, A., Stein, M.B., Cox, B.J., Sareen, J. (2009). Negative attitudes toward help seeking for mental illness in 2 population-based surveys from the United States and Canada. Canadian Journal of Psychiatry, 54(11), 757-766.

Larsson, G., Berglund, A. K., & Ohlsson, A. (2016). Daily hassles, their antecedents and outcomes among professional first responders: A systematic literature review. Scandinavian Journal of Psychology, 57(4), 359-367.

Stuart, H. (2017). Mental illness stigma expressed by police to police. The Israel journal of psychiatry and relational science, 54(1), 18-23.

Occupational Stress Injury. (2019). Retrieved from….