Recognising occupational PTSD as a statutory occupational disease: a step forward for emergency responders’ mental health in China

ABSTRACT

This commentary discusses China’s recognition of occupational post-traumatic stress disorder (PTSD) as a statutory occupational disease, a landmark advancement in mental health support for emergency responders. The policy mandates legal protections, including access to diagnosis, treatment, and compensation, for workers affected by occupational trauma. However, the framework is currently limited to specific professions, such as police officers, healthcare workers, firefighters, and rescue personnel. Additionally, it requires documented trauma exposure during duty, which may exclude workers experiencing cumulative stress from chronic stressors. Furthermore, fragmentation between mental health and occupational health sectors in China impedes the formation of multidisciplinary teams essential for effective PTSD prevention and intervention. To enhance the framework’s efficacy, the authors recommend expanding coverage to include other high-risk professions (e.g. journalists and social workers), improving access to mental health services (particularly in rural areas), implementing preventive measures such as stress management training, and fostering collaborative partnerships across sectors. These strategies are essential for strengthening China’s occupational mental health provisions.

HIGHLIGHTS

• China's recognition of PTSD as a statutory occupational disease for emergency responders marks a significant advancement in mental health support, aligning with international standards and shifting from voluntary to mandatory protections.

• Statutory recognition promotes a cultural shift in workplaces by integrating mental health awareness into organisational practices and alleviating secondary burdens, such as guilt associated with taking leave.

• The framework's current restriction to specific professions and strict requirement of documented trauma exposure raises concerns about excluding workers with cumulative stress, underscoring the need for broader coverage and enhanced access to mental health services.

• Recommendations to enhance the policy’s impact include expanding coverage to additional professions, improving mental health infrastructure, and adopting preventive strategies to better support high-risk workers.

In recent years, there has been growing recognition of the importance of mental health in the workplace (Lee et al., 2020). In China, a significant development occurred on December 11, 2024, when the National Health Commission (NHC), Ministry of Human Resources and Social Security (MHRSS), National Administration for Disease Control and Prevention, and All-China Federation of Trade Unions jointly issued an updated ‘Classification and Catalog of Occupational Diseases’ (National Health Commission of the People’s Republic of China et al., 2024). This policy, effective August 1, 2025, marks a pivotal advancement by recognising occupational post-traumatic stress disorder (PTSD) as a statutory occupational disease for the first time, classified under the code GBZ 337-2025. This code applies to specific high-risk occupational groups, including people’s police, medical personnel, firefighters, and other emergency rescue personnel (see Table 1 for details). However, the diagnosis of occupational PTSD is currently restricted to these professions and requires documented trauma exposure during duty (National Health Commission of the People’s Republic of China, 2025). Despite these limitations, this change addresses a long-standing gap in occupational mental health protection, which has historically focused on physical injuries caused by environmental factors such as physical, chemical, biological, and radiological hazards. This development underscores the Chinese government's commitment to prioritising the mental well-being of high-risk occupational populations. Nevertheless, the persistent mental health challenges faced by these professionals-worsened by large-scale emergencies and chronic occupational stressors-demand further attention to ensure comprehensive support and preventive strategies.

Table 1.

Comparison of Occupational PTSD Diagnostic Criteria: China vs. International Labour Organisation (ILO).

Aspect	China: GBZ 337-2025	ILO: DSM-5/ICD-10/11
Scope	Specific to people’s policea, medical personnelb, and firefighters and other rescue personnelc involved in emergency event handling	Applies broadly to any occupation with exposure to traumatic events
Definition	Delayed or chronic stress reaction post-emergency, causing distress or functional impairment	PTSD as per DSM-5/ICD-10/11, caused by traumatic event exposure, with distress/impairment
Exposure requirement	Participation in handling sudden emergencies (natural disasters, accidents, public health events, or social safety incidents)	Exposure to any traumatic event (not limited to emergencies)
Documented trauma exposure history	Verified history of participation in emergency event handling during duty, confirmed by evidence such as the individual’s statement, documentation from the individual’s affiliated public service agency (detailing the timing and tasks of the response work), testimonials from colleagues or other informed parties, and supplementary written/visual materials	No specific occupational history verification required; allowed clinical judgment without strict documentation, exposure to trauma sufficient
Indirect trauma exposure	Not explicitly stated, prioritising direct exposure in emergency response	DSM-5 explicitly includes indirect exposure (e.g. witnessing, learning about trauma); ICD-11 allows but is stricter
Symptom onset	Must appear within 6 months of exposure	DSM-5 allows immediate or delayed onset (≥6 months for delayed expression); ICD-10 prefers within 6 months; ICD-11 has no strict timeline
Symptom duration	Must persist for over 1 month	Must persist for over 1 month
Core symptoms	Triad: re-experiencing, avoidance, heightened arousal; optional emotional numbness, detachment, or anhedonia	Four clusters: intrusion, avoidance, negative cognition/mood, arousal/reactivity
Diagnostic process	Requires psychiatric evaluation, investigation of emergency event participation, and ruling out other causes	Clinical evaluation per DSM-5/ICD-10/11, no mandatory event investigation.
Exclusion of other causes	Explicitly required through comprehensive analysis, including ruling out other medical or psychiatric conditions	Implied in clinical diagnosis but less emphasised
Implementation	Mandatory standard, effective August 1, 2025	Non-mandatory guidance for global occupational health practice
ICD coding	Not explicitly mentioned in provided text but aligns with ICD-10 (F43.1)	Explicitly uses ICD-10 (F43.1) and ICD-11 (6B40, 6B41) codes
Social Impact	Promoting legal protections, stigma reduction, and cultural integration of mental health support in workplaces, reducing secondary burdens like guilt	Encouraging stigma reduction but lacks specific mandates for workplace cultural integration

^aPeople's police of public security organs, national security organs, prisons, and reeducation-through-labor management organs, as well as the judicial police of the people's courts and people's procuratorates.

^bLicensed physician, registered nurse, pharmacist, medical laboratory technician, medical imaging technician.

^cEmergency rescue personnel responsible for supervising, organising, and executing rescue and relief tasks in handling various natural disasters, accident disasters, and other emergencies (including national rescue), specifically including staff from emergency management departments at all levels, mine safety supervision agencies, and earthquake agencies; personnel from national comprehensive fire rescue teams and local full-time firefighting teams; and personnel from national and local safety production and natural disaster engineering emergency rescue teams.

Since the early twenty-first century, China has encountered numerous large-scale emergencies, including the 2003 SARS epidemic, the 2008 Wenchuan earthquake, the 2014 Kunming Railway Station terrorist attack, the 2015 Tianjin Port explosion, and the 2020–2022 COVID-19 pandemic. These events have not only triggered acute stress and PTSD among survivors but have also imposed substantial psychological burdens on emergency responders (Nagarajan et al., 2022; Wu et al., 2025; Xie et al., 2020). Although attention to survivors’ mental health has increased, the psychological toll on frontline professionals has frequently been neglected within mental healthcare and occupational protection frameworks.

Empirical data highlight the elevated risk of PTSD among Chinese emergency responders, who routinely face traumatic and high-stress situations. For instance, 17.2% of police officers screened positive for PTSD, largely due to frequent encounters with verbal abuse, threats, and non-weapon assaults (Lin et al., 2019). Similarly, 19.9% of frontline healthcare workers who survived COVID-19 and witnessed patient deaths reported PTSD six months after the outbreak (Xiong et al., 2021). Among firefighters, 4.9% met the diagnostic criteria for PTSD, while an additional 22.4% exhibited subclinical symptoms-below the threshold for a full diagnosis but still significant (Zeng et al., 2023). These statistics demonstrate that repeated exposure to trauma not only heightens the risk of PTSD but also leads to more chronic and persistent symptoms, likely due to cumulative stress and the ongoing risk of re-exposure (McFarlane & Bryant, 2007). Consequently, PTSD in these occupational groups has profound and lasting effects, impacting their psychological well-being, occupational functioning, physical health, and interpersonal relationships.

China’s occupational disease prevention and control system has evolved in response to changing socioeconomic conditions. Earlier editions of the Classification and Catalog of Occupational Diseases (issued in 1957, 2002, and 2013) consistently excluded mental and behavioural disorders, reflecting the limited occupational health resources and policy priorities of their times. In recent years, however, a paradigm shift has emerged, driven by two key factors: (a) the increased complexity of emergency rescue operations, as the rising frequency and psychological demands of public emergency response missions-such as disaster relief and accident handling – have heightened mental health risks for emergency workers; and (b) an emerging public health imperative, where the high prevalence of severe psychological trauma among frontline professionals, especially those experiencing distress after rescue operations in the public interest, has prompted policymakers to revise occupational health frameworks.

This policy may help reduce the stigma surrounding mental health problems in China. By recognising these issues as legitimate occupational concerns, it could challenge the cultural prejudice that equates mental health struggles with personal weakness (Chen et al., 2023; Li et al., 2023). This shift may also increase public awareness of mental health and encourage workers to seek help, knowing that their mental health conditions are legally acknowledged and supported.

The inclusion of PTSD in China’s catalog of statutory occupational diseases is a significant advancement, aligning with international standards set by the International Labour Organisation (ILO) (Niu et al., 2022). Table 1 compares China’s diagnostic criteria and policy benefits for occupational PTSD with those of the ILO, demonstrating how China meets global benchmarks while introducing unique mandates. This policy acknowledges the distinct psychological risks faced by emergency responders and sets a precedent for other nations to follow. The 2018 revision of the Occupational Disease Prevention and Control Law of the People’s Republic of China strengthens this framework by shifting mental health protection from a passive, voluntary approach to a proactive, mandatory, and rights-based system. Under this law, employers must implement preventive measures, including psychological risk assessments and trauma management training, and provide mandatory workplace mental health programmes, such as counselling services. The NHC and the MHRSS are authorised to conduct routine inspections to ensure compliance with PTSD prevention protocols and penalise noncompliance. By institutionalising access to diagnosis, treatment, and compensation, this policy reduces stigma, underreporting, and financial burdens for affected workers. Additionally, the inclusion of ‘other emergency rescue personnel’ in the catalog suggests potential expansion to encompass volunteers and private rescue teams, broadening its protective scope.

According to official data from China’s National Fire and Rescue Administration, fire and rescue teams handled over 2.35 million emergency incidents in 2024, not including incidents managed by other emergency rescue forces. The new regulation reflects the commitment to ‘not letting heroes shed both blood and tears,’ prioritising the physical and emotional well-being of these heroic workers while enhancing their professional honour and demonstrating society's respect and care for them. This initiative further promotes workforce well-being and contributes to social stability.

However, several gaps persist in the policy's coverage and implementation. The strict requirement for documented trauma exposure during duty may exclude individuals experiencing cumulative stress from chronic, less overt stressors, such as sustained high-pressure environments or verbal harassment. Furthermore, this requirement presents practical challenges, as it demands the collection and verification of evidence from diverse sources-including personal accounts, official agency documentation, colleague statements, and additional written or visual materials-which may not be readily available (Table 1). The policy's exclusive focus on emergency responders neglects other professions exposed to trauma, such as social workers, psychologists, school counsellors, and disaster relief volunteers, who frequently encounter secondary trauma from supporting trauma victims. Despite legal mandates, access to specialised mental health services remains uneven across China, particularly in rural and under-resourced regions (Zhong & Xiang, 2022). This disparity undermines the overall effectiveness of the policy framework.

These challenges, while significant, do not overshadow the policy’s achievements but rather highlight opportunities to build on its foundation. Beyond legal protections and improved access to mental health services, the statutory recognition of PTSD has embedded awareness into the workplace culture of emergency responders, such as police officers, healthcare workers, and firefighters. This recognition has become an integral part of their organisational fabric. As a result, this cultural shift reduces secondary burdens-such as guilt associated with taking leave for mental health needs-thereby enhancing overall worker well-being (Yin et al., 2023). Addressing these gaps will further strengthen China’s pioneering approach to occupational mental health.

To amplify the strengths of China’s occupational PTSD framework and address its limitations, the following strategies are recommended:

1. Broaden occupational coverage: Extend PTSD recognition to other high-risk professions, such as mental health professionals and journalists, to reflect the diverse nature of occupational trauma.

2. Enhance mental health infrastructure: Increase investment in evidence-based interventions, including trauma-focused Cognitive Behavioural Therapy, Eye Movement Desensitisation and Reprocessing, and peer support programmes (Wang & Li, 2024; Wright et al., 2025). Additionally, deploy mobile mental health units to reduce rural disparities. Adjunctive interventions, such as music and imagery therapy, may also support recovery in specific contexts (Ma et al., 2024).

3. Strengthen preventive measures: Enhance mandatory stress management training, regular mental health screenings, and resilience-building programmes to mitigate PTSD risks.

4. Foster collaborative partnerships: Engage NGOs, mental health specialists, and occupational health workers to share best practices and secure funding for scalable mental health initiatives. Establishing institutionalised collaboration mechanisms between the mental health and occupational health sectors in China is essential to bridge disciplinary silos and effectively address occupational PTSD.

Implementing these strategies will not only address current limitations but also reinforce China’s leadership in occupational mental health.

China’s recognition of occupational PTSD as a statutory disease in 2025 marks a historic step in safeguarding the mental health of emergency responders. This legislative milestone reduces stigma and sets a global benchmark by embedding mental health awareness into workplace culture. It ensures access to diagnosis and treatment, thereby alleviating secondary burdens, such as guilt associated with taking mental health leave. However, to fully realise its potential, China must address diagnostic limitations, expand coverage to other high-risk professions, and strengthen mental health infrastructure, particularly in underserved regions. By building on these achievements, China can provide comprehensive support to its emergency responders, fostering their resilience and well-being. This commentary calls for ongoing innovation and collaboration across sectors to advance China’s occupational mental health policies and practices.

Funding Statement

This work was supported by the [National Natural Science Foundation of China] under [grant number 71774060] and the [Young Top Talent Programme in Public Health from Health Commission of Hubei Province] under [grant number EWEITONG [2021]74].

Disclosure statement

No potential conflict of interest was reported by the authors.