Commercial fishers face a range of stressors that impact physical and mental health. However, there is limited research on the level of mental ill-health among fishers and on the nature of stressors that contribute to their psychological distress. This paper focuses on the experiences of commercial wild-catch fishers and analyses the results of an Australian national survey conducted in 2017 (n = 872) (Appendix S1). We first assess underlying themes in perceived stressors, identifying three distinct categories termed ‘traditional risks’, ‘modern uncertainties’ and ‘future concerns’. Second, we assess the level of self-reported psychological distress, demonstrating higher occurrence of high to very high psychological distress among commercial fishers in comparison with the national population. Third, we examine the relationship between different groups of stressors and psychological distress, finding that stronger perceptions of both ‘traditional risks’ and ‘modern uncertainties’ are associated with greater levels of psychological distress among fishers. Third, recognizing diversity within the industry, we examine differences in these relationships among skippers and crew (work role), and inshore versus offshore fishers (fishing location). Our analysis demonstrates that ‘traditional risks’ and ‘modern uncertainties’ differentially impact on fisher mental health and depend on the individual’s role in the industry and their fishing location. The findings suggest that changes to factors associated with modern uncertainty stressors—including government management techniques, red tape, media representation and political support—could significantly improve mental health in the commercial fishing sector.