Public Safety Personnel (PSP) and Military Personnel (MP) face high rates of potentially traumatic exposures as part of their on-the-job service. As a result, they frequently experience highly impactful Occupational Stress Injuries (OSI), which contribute to complex experiences of mental, health, social, and functional injuries. The individual experience of these injuries is mediated by domain of the causal stressor, including whether it stemmed from an operational factor (i.e., the unique operational demands of the position) or an organizational factor (i.e., systemic stressors associated with employment environment). Military Sexual Trauma (MST) and Military Sexual Misconduct (MSM) are two organizational stressors which involve systemically-normalized sexual violence and discrimination within military environments. MSM and MST unfairly target equity-deserving community members, such as woman-identifying personnel and 2SLGBTQIA+ personnel. By belonging to an equity-deserving community, these communities face an additive impact of distinctive personal factors (e.g., person-specific factors such as gender identity or sexual orientation), which predicate more complex experiences of OSI. In Chapter 2 (Study 1), we qualitatively outline how PSP personally describe their experience of OSI-related PTSD symptoms. In Chapter 3 (Study 2), we qualitatively examine the emotional, social, and functional outcomes of an organizational stressor, MSM, in an equity-deserving community of MP (i.e., woman-identifying military Veterans). Finally, in Chapter 4 (Study 3), we qualitatively assess the mental, social, and functional implications of MST in another equity-deserving population (i.e., the 2SLBTQIA+ military community) using a scoping review methodology. / Thesis / Doctor of Philosophy (PhD) / Public Safety Personnel (PSP) and Military Personnel (MP) experience greater exposure to potentially traumatic experiences as part of their occupational duties than do civilians. As a result, they are more likely to suffer negative mental, social, health, and functional outcomes, known as Occupational Stress Injuries (OSI). The individual expression of OSI is mediated both by the domain of the original stressor (i.e., organizational, or operational), and, by person-specific factors, such as belonging to an equity-deserving population of service. Through qualitative research methods, this thesis examines the mental, social, health and functional outcomes of OSI in military and Public Safety Personnel (i.e., MP and PSP, respectively), as well as how membership in equity-deserving communities impacts these outcomes.

Background: Public safety personnel (PSP) such as paramedics and police are exposed to traumatic situations which increases their risk for mental health issues. However, many PSP do not seek help in a timely manner. Peer support interventions have the potential to decrease stigma and increase treatment-seeking behaviours among PSP. However, little is known regarding how the organizational culture of public safety organizations (PSOs) may affect the implementation of a peer-based intervention. This study aims to understand the extent to which organizational culture, including masculinity contest cultures (MCC), within Canadian PSOs affects implementation of PeerOnCall, a new peer support app for PSP. Methods: A multiple case study design was adopted, integrating semi-structured interviews and a standardized MCC scale completed with organizational champions from three PSOs. Two to three champions from each PSO acted as key informants regarding their organizations. Interviews explored champions’ perceptions of how organizational culture might shape implementation. Interview data were analyzed using inductive thematic analysis. Interview data were also triangulated with MCC scale data to understand the extent to which an MCC exists and is important to consider when implementing this app-based intervention. Results: Interviews with champions resulted in the construction of four themes. The first theme focused on external drivers of organizational culture shift, while the second theme focused on internal drivers. The third theme focused on how culture can create resistance to implementation. The fourth theme emphasized that culturally competent implementation strategies could overcome this resistance Most participants perceived their organization to have low-to-moderate levels of MCC. Discussion/Conclusions: Each organization had a unique and changing culture, as evidenced through its cultural artifacts, beliefs, and values. Understanding how culture shapes implementation of PeerOnCall can guide the creation of contextually relevant strategies that optimize implementation of PeerOnCall within PSOs. Recommendations for strategies and further study are provided. / Thesis / Master of Public Health (MPH) / This multi-site case study explores how first responder culture influences implementation of the PeerOnCall peer support app. Interviews and surveys were conducted with seven workplace champions from one police and two paramedic organization(s). Interviews explored organizational culture in general while surveys focused on masculinity contest culture specifically. It was observed that: external and internal drivers of culture shift have created a window of opportunity for PeerOnCall implementation; cultures of mistrust, skepticism & apathy, and hegemonic masculinity can create resistance to implementation; and culturally competent implementation strategies can overcome this. Traditional norms of masculinity appeared to be changing within the organizations. While public safety organizations’ cultures have been studied, this study links culture to the implementation of a specific intervention and offers nuance to the issue of masculinity contest cultures. Findings can inform the creation of culturally competent strategies that optimize the implementation of resources such as PeerOnCall among first responders.

Healthcare workers (HCWs) and public safety personnel (PSP) are at an elevated risk for adverse mental health outcomes, including PTSD, anxiety, depression, and increased suicidality. Workplace challenges and burdens were exacerbated by the COVID-19 pandemic, which further highlighted the physical and mental health vulnerabilities of HCWs and PSP. As a result, there has been a growing interest from mental health professionals and researchers in understanding the unique stresses and mental health risks these individuals face. Moral injury (MI), a phenomenon linked to the unique experiences of HCWs and PSP, has been associated with adverse mental health outcomes. Cognitive impairments, such as memory disturbances, are also frequently observed in these populations. This thesis explored the relation between MI and memory disturbances and how this relation was impacted by emotion regulation (ER) and self-compassion (SC). In addition, we investigated how SC and ER influenced the relation between MI and adverse childhood experiences (ACEs). In the first study of this thesis, we explored these relations through a series of correlational, moderated mediation analyses of self-report measures collected among HCWs and PSP during the COVID-19 pandemic. These analyses revealed significant relations between MI and memory disturbances, where higher levels of moral injury were associated with elevated levels of memory disturbances, particularly in relation to subscales of guilt and shame. Interestingly, these effects were moderated by ER and mediated by SC at high levels of ER difficulties. In the second study of the thesis, we conducted various correlational analyses as well as explored the relation between MI and ACEs alongside the impacts of SC and ER through moderated mediation analysis. The analyses in this study revealed significant relations between MI and ACEs regarding the mediating effect of SC and the moderating effect of ER at medium and low levels of ER difficulties. / Thesis / Master of Science (MSc)