Stress First Aid: A Peer Support Framework for Addressing Occupational Stress Injury in Military and Other High-Risk Occupations
Patricia WatsonBackground
Prolonged deployments, hybrid warfare, and expanding disaster-response missions expose service members to cumulative occupational stress that erodes readiness, retention, and long-term health. Between universal resilience training and formal clinical care lies a persistent gap: practical actions that peers and leaders can take when a coworker is strongly affected by stress. Stress First Aid (SFA) is a flexible, peer- and leader-delivered framework derived from the U.S. Navy and Marine Corps Combat and Operational Stress First Aid program and organized around five empirically supported protective elements in the recovery from ongoing adversity—safety, calming, connectedness, self-efficacy, and hope—translated into seven core actions.
Methods
This commentary summarizes the conceptual foundations of SFA and reviews published evaluations of SFA adaptations conducted between 2022 and 2025, encompassing 17 studies and over 3,000 participants across healthcare, fire service, nursing education, and related high-stress occupations, together with implementation findings relevant to military adoption.
Results
Across designs ranging from cluster randomized trials to a 12-month multi-hospital longitudinal evaluation, SFA shows consistent improvements in proximal outcomes—stress recognition, peer-support self-efficacy, group cohesion, perceived organizational support, and use of well-being resources—with more modest and less consistent effects on distal outcomes such as posttraumatic stress symptoms and burnout. Benefits appear strongest among younger workers and in settings with higher implementation fidelity.
Conclusion
SFA offers military organizations a scalable, low-burden, culturally adaptable layer of stress-injury care that complements both momentary acute stress protocols and formal treatment. Rigorous effectiveness trials in military settings are the priority next step.