Meta-analysis of risk factors for secondary traumatic stress in therapeutic work with trauma victims

Estrutura Interna da Versão Brasileira do Questionário de Estresse Traumático Secundário

Resumo O Estresse Traumático Secundário caracteriza-se por um conjunto de sintomas e condutas que se manifestam após a exposição indireta ao trauma. Profissionais que cuidam de pessoas traumatizadas estão susceptíveis ao transtorno. Este estudo examinou a estrutura interna da versão brasileira do Cuestionario de Estrés Traumático Secundario. Participaram 624 profissionais da saúde, acessados on-line. Para realização das análises fatoriais, a amostra foi dividida em dois grupos. Na análise exploratória, foram retidos 12 componentes, com cargas fatoriais entre 0,312 e 0,999. Os resultados da análise confirmatória revelaram que o modelo de doze fatores para 50 itens forneceu o melhor ajuste possível para os dados (RMSEA = 0,044; IC = 10%-90%; CFI = 0,949; TLI = 0,904) e índice de consistência interna geral do modelo foi de 0,91. Esses doze fatores foram distribuídos em quatro escalas (Antecedentes, Síndrome de Trauma Secundário, Personalidade e Consequências), com índices psicométricos relativamente baixos e uma nova organização dos itens das escalas do QETS, em contraste com a versão teórica original do instrumento. Sugere-se que novos estudos psicométricos analisem as escalas do questionário, separadamente, e investiguem outras categorias profissionais, especialmente na área dos serviços de emergências, além de estudos comparativos com amostras clínicas.

Self-worth and bonding emotions are related to well-being in health-care providers: a cross-sectional study

BACKGROUND

Interacting with patients can elicit a myriad of emotions in health-care providers. This may result in satisfaction or put providers at risk for stress-related conditions such as burnout. The present study attempted to identify emotions that promote provider well-being. Following eudaimonic models of well-being, we tested whether certain types of emotions that reflect fulfilment of basic needs (self-worth, bonding with patients) rather than positive emotions in general (as suggested by hedonic models) are linked to well-being. Specifically, we hypothesized that well-being is associated with positive emotions directed at the self, which reflect self-worth, and positive as well as negative emotions (e.g., worry) directed at the patient, which reflect bonding. However, we expected positive emotions directed at an object/situation (e.g., curiosity for a treatment) to be unrelated to well-being, because they do not reflect fulfilment of basic needs.

METHODS

Fifty eight physicians, nurses, and psychotherapists participated in the study. First, in qualitative interviews, they reported their emotions directed at the self, the patient, or an object/situation during distressing interactions with patients. These emotions were categorised into positive emotions directed towards the self, the patient, and an object/situation, and negative emotions directed towards the patient that reflect bonding. Second, providers completed questionnaires to assess their hedonic and eudaimonic well-being. The well-being scores of providers who did and did not experience these emotions were compared.

RESULTS

Providers who experienced positive emotions directed towards the self or the patient had higher well-being than those who did not. Moreover, for the first time, we found evidence for higher well-being in providers reporting negative patient-directed emotions during distressing interactions. There was no difference between providers who did and did not experience positive object/situation-directed emotions.

CONCLUSIONS

These findings may point towards the importance of "eudaimonic" emotions rather than just positive emotions in interactions with patients. Emotions such as contentment with oneself, joy for the patient's improvement, and, notably, grief or worry for the patient may build a sense of self-worth and strengthen bonding with the patient. This may explain their association with provider well-being.

Extent and predictors of work-related distress in community correction officers: a systematic review

Research indicates that indirect exposure to trauma can have a detrimental psychological impact on professionals working within, and interfacing with, law enforcement and the criminal justice system. This systematic review aimed to explore the extent and predictors of work-related distress amongst community corrections personnel. A search of five databases identified 19 papers eligible for inclusion; 16 addressed burnout, and the remainder investigated secondary trauma, vicarious trauma and compassion fatigue. Synthesis revealed that community corrections personnel reported burnout at levels akin to those of other professions working in forensic contexts, though reports of secondary trauma appeared higher. Predictive factors encompassed personal, role-based and organisational factors. Research reporting work-related distress in correctional officers is focused on burnout but uses divergent models of stress, reveals methodological weaknesses, and to date has little examined responses to indirect trauma. The limitations of this review are discussed, alongside clinical implications and areas for future research.

Advancing a Model of Secondary Trauma: Consequences for Victim Service Providers

A burgeoning body of scholarship is attempting to understand, normalize, and ameliorate the emotional strain of victim service provision. The literature, however, has yet to fully theorize the hazardous process of empathetic engagement with victims. As a result, concepts, mechanisms, and outcomes are often conflated, making it difficult to understand the etiological path of this occupational risk. The goal of this article is to attend to this gap by accomplishing three objectives. The first is to engage with the perspective of symbolic interaction to theoretically ground a conceptual model of secondary trauma. The second objective is to propose a model of secondary trauma that acknowledges its inherently interactional, interpretive, and, thus, vicariously transmissible nature. The third objective is to begin the work of empirically supporting this model with data from a sample of victim service providers (n = 94) collected using in-depth interviews, focus groups, ethnographic participant observation, and community-based participatory research. Our findings suggest that victim service provision, in the form of empathetic engagement, can blur the boundary between self and other, and lead to a sense of damage in the self that manifests in unreliable self-agency, untrustworthy coherence of other, desensitized self-affectivity, and fractured self-history. This work has significant implications. We illustrate an important paradox by showing how victim service provision can be helpful to victims but harmful to providers. We also offer a pathway for reducing this harm. By specifying mechanisms of damage, the model can be used to inform policies and practices supportive of victim service providers' health and well-being.

Factors Associated with Providers' Work Engagement and Burnout in Homeless Services: A Cross-national Study

The complexity of homeless service users' characteristics and the contextual challenges faced by services can make the experience of working with people in homelessness stressful and can put providers' well-being at risk. In the current study, we investigated the association between service characteristics (i.e., the availability of training and supervision and the capability-fostering approach) and social service providers' work engagement and burnout. The study involved 497 social service providers working in homeless services in eight different European countries (62% women; mean age = 40.73, SD = 10.45) and was part of the Horizon 2020 European study "Homelessness as Unfairness (HOME_EU)." Using hierarchical linear modeling (HLM), findings showed that the availability of training and supervision were positively associated with providers' work engagement and negatively associated with burnout. However, results varied based on the perceived usefulness of the training and supervision provided within the service and the specific outcome considered. The most consistent finding was the association between the degree to which a service promotes users' capabilities and all the aspects of providers' well-being analyzed. Results are discussed in relation to their implications for how configuration of homeless services can promote social service providers' well-being and high-quality care.

Compassion Fatigue Among the Intimate Partner Violence and Sexual Assault Workforce: Enhancing Organizational Practice

Gaps in knowledge related to occupational stress among the intimate partner violence (IPV) and sexual assault (SA) workforce remain. This study examined associations between key risk factors for occupational stress and compassion fatigue among a sample of IPV/SA service providers in the Southwestern United States (N = 520). Results of the hierarchical regression analysis identified microaggressions, age, recent life stress, direct practice, and workload as factors associated with compassion fatigue. The findings point to the importance of incorporating trauma-informed organizational approaches to address microaggressions, reduce workload, and support staff experiencing recent stress and providing direct services.

Intersectionality and Invisible Victims: Reflections on Data Challenges and Vicarious Trauma in Femicide, Family and Intimate Partner Homicide Research

Rigorous, comprehensive and timely research are the cornerstone of social and transformative change. For researchers responding to femicide, family and intimate partner homicide, there are substantial challenges around accessing robust data that is complete and fully representative of the experiences and social identities of those affected. This raises questions of how certain social identities are privileged and how the lens of intersectionality may be constrained or enabled through research. Further, there is limited insight into the emotional labour and safety for researchers, and how they experience and mitigate vicarious trauma. We examine these issues through a shared critical reflection and conclude with key recommendations to address the challenges and issues identified. Four researchers examining and responding to femicide, family and intimate partner homicide in Australia, Canada and the United Kingdom shared and evaluated their critical reflection. We drew on our experiences and offer insights into processes, impacts and unintended consequences of fatality reviews and research initiatives. There are substantial limitations in accessibility and completeness of data, which has unintended consequences for the construction of social identities of those affected, including how multiple forms of exclusion and structural oppression are represented. Our experiences as researchers are complex and have driven us to implement strategies to mitigate vicarious trauma. We assert that these issues can be addressed by reconceptualizing the goals of data collection and fostering collaborative discussions among those involved in data collection and violence prevention to strengthen research, prevention efforts and safety for all involved.

A Large-Scale Survey on Trauma, Burnout, and Posttraumatic Growth among Nurses during the COVID-19 Pandemic

A large-scale survey study was conducted to assess trauma, burnout, posttraumatic growth, and associated factors for nurses in the COVID-19 pandemic. The Trauma Screening Questionnaire, Maslach Burnout Inventory, and Posttraumatic Growth Inventory-Short Form were utilized. Factors associated with trauma, burnout, and posttraumatic growth were analysed using logistic and multiple regressions. In total, 12 596 completed the survey, and 52.3% worked in COVID-19 designated hospitals. At the survey's conclusion in April, 13.3% reported trauma (Trauma ≥ 6), there were moderate degrees of emotional exhaustion, and 4,949 (39.3%) experienced posttraumatic growth. Traumatic response and emotional exhaustion were greater among (i) women (odds ratio [OR]: 1.48, 95% CI 1.12-1.97 P = 0.006; emotional exhaustion OR: 1.30, 95% CI 1.09-1.54, P = 0.003), (ii) critical care units (OR: 1.20, 95% CI 1.06-1.35, P = 0.004; emotional exhaustion OR: 1.23, 95% CI 1.12-1.33, P < 0.001) (iii) COVID-19 designated hospital (OR: 1.24, 95% CI 1.11-1.38; P < 0.001; emotional exhaustion OR: 1.26, 95% CI 1.17-1.36; P < 0.001) and (iv) COVID-19-related departments (OR: 1.16, 95% CI 1.04-1.29, P = 0.006, emotional exhaustion only). To date, this is the first large-scale study to report the rates of trauma and burnout for nurses during the COVID-19 pandemic. The study indicates that nurses who identified as women, working in ICUs, COVID-19 designated hospitals, and departments involved with treating COVID-19 patients had higher scores in mental health outcomes. Future research can focus on the factors the study has identified that could lead to more effective prevention and treatment strategies for adverse health outcomes and better use of resources to promote positive outcomes.

Online narrative exposure therapy for parents of children with neurodevelopmental disabilities suffering from posttraumatic stress symptoms - study protocol of a randomized controlled trial

BACKGROUND

Parents of children with intellectual and neurodevelopmental disorders (IDD) often experience traumatic events in the care of their children. This leads to comparatively high numbers of mental health problems such as posttraumatic stress disorder (PTSD) in those parents. Intervention approaches for parents of children with IDD are scarce and many parents remain without support.

OBJECTIVE

This study aims to test the feasibility and efficacy of online Narrative Exposure Therapy (eNET) with parents of children with IDD.

METHODS

The study follows a randomized waitlist-control design. eNET is an exposure-based PTSD intervention and includes 8-12 90-minute sessions. All sessions will be conducted via video calls with trained paraprofessionals. We aim to include 50 parents, approximately 25 in the immediate intervention group and 25 in the waitlist group. Waitlist participants will receive the same intervention after a three-month wait period. All participants need to either fulfill full or subclinical PTSD symptoms according to DSM-5. Feasibility and efficacy of the intervention will be measured with pre, post, and 2 and 6 months follow-up surveys focusing on PTSD symptoms. Secondary outcomes include other health-related outcomes such as physical symptoms, depression symptoms, anxiety symptoms and functionality.

CONCLUSIONS

The proposed study allows us to test the feasibility and efficacy of eNET in a sample of parents of children with IDD. There are so far no published studies on the evidence of eNET; this study is one of the first randomized controlled trials investigating the feasibility and efficacy of eNET and therefore will have implications on further research and practice.Clinical trial registration: NCT04385927Date and version identifier: 22 July 2021.

Secondary trauma and impairment in clinical social workers

BACKGROUND

Secondary traumatic stress (STS), symptomatology resulting from indirect exposure to trauma, is one potential negative effect from engaging in clinical social work. Yet, little is known about the relationship between STS and workers' distress and impairment due to their work.

OBJECTIVE

The purpose of this paper was to explore STS in a national sample of clinical social workers (N = 539).

METHOD AND RESULTS

A structural equation model demonstrating good model fit indicated that STS mediated the association between trauma exposure at work and reports of significant distress and impairment (β = .08, p < .01; 95 % CI = .03, .12). Likewise, STS mediated the association between working with children aged 13 and under and reports of significant distress and impairment (β = .05, p < .05; 95 % CI = .02, .09). Results indicated that the model accounted for 25 % of the variance in significant distress and impairment (R² = .25, p < .001) and 5% of the variance in STS (R² = .05, p < .05).

CONCLUSIONS

Implications for agencies working with child welfare are provided, including a discussion of addressing STS and significant distress and impairment at the individual and larger agency levels.

Factors Associated With Secondary Traumatic Stress Among Nurses in Regional Trauma Centers in South Korea: A Descriptive Correlational Study

INTRODUCTION

Trauma is a leading cause of death in South Korea. This study aimed to identify the factors associated with secondary traumatic stress of nurses working at regional trauma centers.

METHODS

A survey-based cross-sectional design was utilized. Data were collected through a structured questionnaire consisting of 5 rating scales and demographic data. Data were analyzed via descriptive statistics, t test, analysis of variance, Pearson's correlation, and multiple regression.

RESULTS

One hundred eighty-six nurses participated, and most (84.4%) reported moderate to severe secondary traumatic stress. Exposure to traumatic events averaged 34.33 (SD = 6.25) out of 65 points. Average problem-focused coping was 3.00 (SD = 0.37), emotion-focused coping was 2.57 (SD = 0.26), and dysfunctional coping was 2.17 (SD = 0.41) out of 4 points. Social support from family and friends averaged 5.85 (SD = 0.75), social support from coworkers was 5.78 (SD = 0.83), and social support from supervisors was 4.65 (SD = 1.18) out of 7 points. The factors affecting the respondents' secondary traumatic stress were type D personality (β = 0.39, P < .001), dysfunctional coping (β = 0.28, P < .001), problem-focused coping (β = 0.19, P < .01), desire for job rotation (β = 0.17, P < .01), and social support from supervisors (β = -0.12, P = < .05). This regression model was statistically significant and the explanatory power was 46.7% (F = 33.47, P < .001, Adj R² = 0.47).

DISCUSSION

Along with a personal effort to engage in stress management programs, administrators, managers, and supervisors should prioritize developing practical strategies for reducing secondary traumatic stress of nurses.

Disseminating Trauma-Focused Cognitive Behavioral Therapy with a Systematic Self-care Approach to Addressing Secondary Traumatic Stress: PRACTICE What You Preach

This pilot study evaluated the effectiveness of Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) training programs augmented with a systematic "PRACTICE What You Preach" (PWYP) self-care focus, which has trainees personally utilize the coping skills they teach their clients. Participants were 115 clinicians/supervisors who completed a PWYP TF-CBT training program. Pre- to post-training analyses documented significant increases in participants' competency and fidelity in implementing TF-CBT (ps < .001), significantly more frequent use of coping skills including instrumental social support (p < .01), active coping (p < .001), humor (p < .01), and restraint (p < .01), and significant decreases in secondary traumatic stress (STS; p < .001). Children's symptoms of PTSD (ps < .001) and behavior problems (p < .05) also decreased significantly. This preliminary evidence suggests that training augmented with PWYP may enhance clinicians'/supervisors' personal coping and reduce their levels of STS without compromising treatment implementation efforts and client outcomes.

Latent structure of secondary traumatic stress, its precursors, and effects on people working with refugees

The study aims to examine the latent structure of secondary traumatic stress (STS), its precursors, and the psychological effects of it on the population of service providers working with refugees passing through the Balkan route. A total of 270 service providers (57% female) of different professional backgrounds working directly with refugees took part in the study. Participants were assessed for STS using the Secondary Traumatic Stress Scale, the extent of secondary exposure to trauma (i.e., clients’ traumatic experiences from the countries of origin and travel that were communicated to them directly), depression, anxiety, and quality of life. Comparisons of several confirmatory factor analyses following prominent PTSD conceptualizations showed that the model with three relatively distinct but highly correlated factors–intrusion, avoidance, and the blend of negative alterations in cognitions, mood, and reactivity (NACMR), had the best fit. STS has been shown to be positively correlated both with the amount of different traumatic experiences that were communicated to them as well as with the specific content of those experiences. Path analysis showed that the amount of secondary exposure to the clients’ traumatic experiences during travel, but not in the country of origin, had exclusive relationships with all three factors of STS. NACMR demonstrated direct effects on anxiety and depression symptoms, while intrusions exhibited a direct effect on anxiety-related symptomatology only. The avoidance factor did not have any independent direct effects on anxiety or depression. Finally, the effects of STS factors on quality of life were fully mediated by an increase of depression-related symptomatology. Results provide evidence on the latent structure of the STS which partially deviates from the prominent models of PTSD thus questioning the isomorphism of two constructs on the empirical level. Additionally, findings provide insights on the cascade of events that make professionals working with traumatized people especially vulnerable to STS and broader psychological distress.

A Systematic Review of Job Demands and Resources Associated with Compassion Fatigue in Mental Health Professionals

Psychosocial hazards in mental healthcare contribute to the development of compassion fatigue in mental health professionals. Compassion fatigue has a negative impact on the mental health and wellbeing of professionals that can impair the quality of services provided to clients. The majority of research on compassion fatigue has focused on individual-level variables such as gender, history of trauma and age, among others. It is also imperative to understand the role played by alterable work-related characteristics in contributing to the development of compassion fatigue in order to attenuate its impact on mental health professionals and their clients. The present review examined articles exploring work-related factors associated with compassion fatigue. Fifteen quantitative studies were included and their quality was assessed using a checklist. An inductive content-analysis approach was adopted to synthesise the themes emerging from the data. The results suggested a theoretical model consistent with the Job Demands-Resources model, wherein job demands (such as workplace trauma, workload and therapeutic settings) are associated with compassion fatigue, and job resources (such as supervisors', coworkers' and organisational support) mitigate the impact of job demands. In addition to person-oriented factors, work-related factors are critical for the prevention of compassion fatigue.

Risk of Secondary Traumatic Stress in Treating Traumatized Military Populations: Results from the PTSD Clinicians Exchange

INTRODUCTION

This study examined risk factors for secondary traumatic stress (STS) in behavioral health clinicians and whether access to the Post-Traumatic Stress Disorder (PTSD) Clinicians Exchange website mitigated STS risk.

METHODS

A diverse sample of clinicians (N = 605) treating traumatized military populations in Department of Veterans Affairs (VA), Department of Defense, and community practice settings were randomized to a newsletter-only control group or the exchange group. The exchange website included resources for treating PTSD and promoting clinician well-being. Online surveys were administered at 0-, 6-, and 12-months postrandomization. Regression analyses were used to examine the link among risk factors, exchange access, and STS.

RESULTS

Baseline clinician demographics, experience, total caseload, appeal of evidence-based practices (EBPs), and likelihood of adopting EBPs if required were not linked with STS at the 12-month assessment period. Providing care at the VA, more burnout, less compassion satisfaction, greater trauma caseload, less openness to new EBPs, and greater divergence from EBP procedures were linked with greater STS. Only burnout and divergence were associated with STS after accounting for other significant STS risk factors. Exchange and control group clinicians reported similar STS levels after accounting for burnout and divergence.

CONCLUSIONS

Given that burnout was linked with STS, future intervention may use techniques targeting burnout and STS (eg, emotion regulation strategies). Research exploring the link between divergence from EBPs and STS may inform EBP dissemination efforts and STS interventions. Finally, results highlight the need for research optimizing STS intervention efficacy among clinicians treating military populations.

Transformational Leadership and Turnover Intention in Child Welfare: A Serial Mediation Model

PURPOSE

This study examined a serial mediation model testing the effects of STS on turnover intention through executive leaders' use of transformational leadership as perceived by child welfare workers and then organizational commitment while controlling for age, gender, and social work degrees.

METHOD

Survey data were collected from 264 child welfare workers at one Midwestern state.

RESULTS

The results supported the serial mediation model, corroborated by the finding that the impact of STS on turnover intention has disappeared as a result of transformational leadership and organizational commitment between the two variables.

DISCUSSION

The findings of the study provide practical implications for training transformational leadership styles to leaders training at the middle manager and executive leadership levels in child welfare agencies.

Psychiatric Sequelae Among Community Social Service Agency Staff 1 Year After a Mass Shooting

This cross-sectional study examines the prevalence of mental health disorders and substance use among professional staff members at community social service agencies 1 year after a mass shooting in Pittsburgh, Pennsylvania.

Differences in the association of spirituality, forgiveness, PTSD and stress among social workers and social work students treating trauma survivors

Providing professional assistance to trauma victims may cause significant emotional distress to those who provide the assistance. Dealing with such stress requires attention to significant personal resources. This study examined the relationship between tendency to forgive and spirituality with PTSD symptoms and stress among social workers and social work students (N = 157) who are at the front line dealing with trauma survivors. The study results demonstrated that social work students had higher levels of stress while no significant differences were found regarding spiritually, PTSD, and forgiveness. Examining the subscales revealed that social work students had higher negative PTSD alteration symptoms than trained social workers while trained social workers had higher levels of forgiveness to self. Additionally, structural equation models showed that among social workers, forgiveness to self and spirituality were associated simultaneously with lower PTSD symptoms and stress. However, among social work students, the tendency to forgive the self was associated with lower PTSD symptoms only. The findings illuminate spirituality and forgiveness as key factors that can help cope with the emotional toll of those who assist trauma survivors, while focusing on differences for trained professionals and training professionals. Theoretical and clinical implications are discussed.

Secondary Trauma and Parenting Practices in Internet Crimes against Children Task Force Investigators

Investigating cases of child pornography requires daily exposure to sexually explicit material involving children and may have negative implications on the mental well-being of those in this line of work. This study aimed to identify whether secondary traumatic stress symptoms were associated with participants' parenting behaviors and concerns about their own children's use of the internet. Internet Crimes Against Children Task Force workers (n = 212) completed online questionnaires measuring work exposure to sexually explicit material, secondary traumatic stress symptoms, and parenting behaviors. Professionals in this field reported a wide range of secondary trauma symptoms, and their parenting behaviors were both directly and indirectly (via secondary trauma) affected by prolonged exposure to sexually explicit material involving children. Internet monitoring behaviors were more prevalent for parents of younger children, and mothers' parenting behaviors were more strongly associated with secondary trauma symptoms than were fathers. Results have implications for mental health and parenting services for professionals in this field.

Towards trauma-informed legal practice: a review

Vicarious or secondary trauma experience has always been part of legal practice although many do not acknowledge the risk it can have on the mental health, well-being and performance of legal professionals. The listening to, observing and then detailing of traumatic events for the purposes of legal process in some cases may harm lawyers who need to work closely with clients, victims and witnesses. This article reviews the research on trauma in many areas of professional human services that could inform and improve our understanding of legal practice. It examines the discursive history of trauma and recent studies on lawyer well-being, before discussing the controversies about recognising vicarious trauma and the stigma against mental health concerns in the legal profession. The article concludes by reviewing options to assist law firms in considering trauma-informed policy, practices and supervision strategies and to help individual lawyers recognise the value of self-care.

Secondary Traumatic Stress, Mental State, and Work Ability in Nurses-Results of a Psychological Risk Assessment at a University Hospital

Psychological risk assessment is a legal obligation for companies and part of occupational safety and employment protection in Germany. However, data from psychological risk assessments in nursing staff are scarce, although this population is at increased risk for secondary traumatic stress by patient experienced trauma. Therefore, our study aimed at examining the frequency of reported secondary trauma events, secondary traumatic stress, and its possible consequences for psychological well-being and work ability in nurses. N = 320 nurses (n = 280 female) were assessed at a University Hospital in Germany as part of the psychological risk assessment. Secondary traumatic events, secondary traumatic stress, and symptoms of depression and anxiety were measured using self-report questionnaires (PHQ-2, GAD-2), and work ability was assessed using a modified version of the questionnaire for workplace analysis (KFZA). Of 320 nurses, 292 (91.2%) experienced secondary trauma, and 74 nurses (25.3%) reported secondary traumatic symptoms. Nurses with secondary traumatic symptoms reported higher depression (p < 0.001) and anxiety scores (p < 0.001) compared to nurses without secondary trauma experience, and to nurses with secondary trauma experience but without secondary traumatic stress (both p < 0.001). Further, nurses with secondary traumatic stress reported significantly reduced work ability, social support and control over work, and increased emotional strain and labor time. Nurses with secondary traumatic stress may be at increased risk of developing major depression and anxiety disorders, and particularly need support in overcoming secondary traumatic experiences. Psychological risk assessment is a useful tool to identify groups at risk, and pave the way to implement strategies to improve mental well-being and prevent work ability in high risk groups.

Secondary traumatisation, burn-out and functional impairment: findings from a study of Danish child protection workers

Background: Child-protection workers are at elevated risk for secondary traumatization. However, research in the area of secondary traumatization has been hampered by two major obstacles: the use of measures that have unclear or inadequate psychometric properties and equivocal findings on the degree of associated functional impairment. Objective: To assess the relationship between secondary traumatization and burnout using exploratory structural equation modelling (ESEM) and to assess the relationship between secondary traumatization and functional impairment. Methods: A survey of Danish child-protection workers was conducted through the Danish Children Centres (N = 667). Secondary traumatization was measured using the Professional Quality of Life-5 (ProQoL-5) and burnout using the Oldenburg Burnout Inventory. Results: A three-factor ESEM model provided the best fit to the data, reflecting factors consistent with the structure of secondary traumatization and burnout. The factors were differentially related to trauma-related and organizational variables in ways consistent with existing evidence. All factors were significantly related to functional impairment. Conclusion: The findings supported the discriminant validity of secondary traumatization and burnout while highlighting methodological issues around the current use of sum-score approaches to investigating secondary traumatization. The current study supported the clinical relevance of secondary traumatization by linking it explicitly to social and cognitive functional impairment.

PROFESSIONAL QUALITY OF LIFE AND COPING IN A REFERENCE HOSPITAL FOR VICTIMS OF SEXUAL VIOLENCE

ABSTRACT Objective: to verify the relationship between professional quality of life scores and coping strategies in the multidisciplinary health team that assists children and adolescents victims of sexual violence. Method: a cross-sectional study carried out in a public hospital of Porto Alegre, Brazil. Data collection took place from July to October 2018, using the Professional Quality of Life Scale and the Inventory of Coping Responses at Work. The analysis was performed using the Kruskal-Wallis test and Pearson's Correlation Coefficient. Regression was used for independent variables with p ≤ 0.05 in the bivariate analyses. Results: the professionals showed a medium level in the compassion satisfaction dimension (54.2%), medium level for secondary traumatic stress (50.8%), and medium level for Burnout (61%). Regarding the coping strategies, the decision-making strategy showed a weak correlation with the compassion satisfaction dimension (0.261), and the emotional extravasation strategy showed a moderate correlation with secondary traumatic stress (0.485) and Burnout (0.399). The female gender was associated with secondary traumatic stress (p=0.002). Conclusion: the identification of coping strategies such as decision-making can help the professionals to increase the levels of compassion satisfaction. In situations of suffering in daily work, management to avoid emotional extravasation should take place, preventing high levels of compassion fatigue. Such information is important to support public policies on occupational health, as well as programs to promote occupational health.

The cost of caring: secondary traumatic stress and burnout among lay trauma counsellors in the Western Cape Province

The psychological and emotional risks associated with providing care to traumatized populations have been largely overlooked in the literature on non-professional trauma counselling in South Africa. Non-professional or lay trauma counsellors are frontline service providers and typically the first point of contact for people in community contexts who have experienced traumatic events. The main aim of this study was to investigate the professional quality of life including compassion satisfaction, secondary traumatic stress, and burnout of a sample ( N = 146) of lay trauma counsellors in the Western Cape Province. Demographic factors including age and gender were found to be significant. Older age was associated with compassion satisfaction while younger age predicted burnout. Male lay trauma counsellors were more likely to report high burnout and high secondary traumatic stress compared with their female counterparts. The study underscores the need for organizations to incorporate prevention and intervention approaches to mitigate the negative psychological impact of working with trauma. Male lay trauma counsellors and younger counsellors may particularly benefit from interventions that encourage debriefing.

Secondary Traumatic Stress in Foster Carers: Risk Factors and Implications for Intervention

OBJECTIVES

Fostering, a professional or semi-professional role that is in increasing demand, involves potential exposure to material related to children's trauma in a domestic setting. Yet, professional vulnerability to secondary traumatic stress (STS) is under-researched in foster carers, as is the suitability of associated intervention techniques. We therefore investigated incidence of STS and psychological predictors relevant to secondary and primary stress appraisal in UK foster carers.

METHODS

British foster carers (n = 187; 81% female; aged 23-72 years; mean length of experience 9 years) were approached through a range of organizations managing paid foster caring in the UK for a survey study. Self-report measures were obtained on STS, burnout and compassion satisfaction from the Professional Quality of Life (ProQOL) scale, as well as on primary trauma and variables previously recommended for inclusion in training targeting secondary trauma: empathy, resilience and self-care.

RESULTS

High levels of STS and burnout were found among foster carers. In multivariate model testing, STS was directly and positively predicted by burnout, compassion satisfaction and primary trauma (R ² = 0.54, p < 0.001). Resilience, empathy and self-care did not show direct associations with STS, but self-care had a significant indirect effect on STS.

CONCLUSIONS

Findings support the view that STS is a substantial risk factor in foster caring. While self-care is confirmed as a promising factor in intervention, the roles of empathy and resilience are more ambiguous.

Be well: A systems-based wellness intervention using mindfulness in the workplace – A case study

Introduction: Healthy work environments are essential in determining improved well-being of Australians. Job stress has been identified as a significant factor in psychological distress. This study evaluated the effect of introducing a systems-based workplace wellness programme using mindfulness in the workplace. Methods: The programme ‘Be Well’ was introduced as part of a systems-based approach to workplace health promotion, and evaluated using sick leave as a proxy for workplace stress, and the stress satisfaction offset score to determine the degree of change in stress and satisfaction. Results: There was significant reduction in sick leave (2014 vs. 2012) (p<.001), and significant improvement in stress satisfaction offset score (p<.05). Logistic regression analysis identified the programme components most predictive of reduced stress and higher job satisfaction. Conclusion: The impacts of a systems-based mindfulness workplace wellness intervention, show significant improvements in workers’ sick leave and changes to stress and satisfaction scores. This study has implications for sector-wide policy change in the workplace.

Therapist mindfulness and subjective vitality: the role of psychological wellbeing and compassion satisfaction

BACKGROUND

Mindfulness and vitality are related constructs in the literature; however, mindfulness and vitality have not been fully examined in the literature, specifically with mental health therapists.

AIMS

This study aimed to investigate the relationship between mindfulness and vitality among a sample of licensed mental health clinicians. Compassion satisfaction (CS) and psychological wellbeing are further explored as mechanisms by which a therapist may experience vitality and the impact mindfulness may have on these mechanisms.

METHODS

Mediation analyses were utilized to understand the relationship between mindfulness and vitality and the indirect paths of psychological wellbeing and CS.

RESULTS

Results indicate that therapists with greater mindfulness report more vitality, higher overall psychological wellbeing and higher CS. As expected, the relationship between mindfulness and vitality was mediated by psychological wellbeing and CS. Results support the existing research on the relationship between mindfulness and vitality.

CONCLUSIONS

Understanding the importance of psychological wellbeing and CS has implications for addressing the high incidences of the negative impact of therapeutic work.

Development and Psychometric Assessment of Risk Factors of Compassion Fatigue Inventory in Nurses

BACKGROUND AND PURPOSE

Identifying the risk factors of compassion fatigue is the basic step in designing effective interventions to prevent and manage compassion fatigue. This study developed an inventory of compassion fatigue risk factors and investigated its psychometric properties.

METHODS

This methodological study consisted of two phases: item pool generation through semistructured interviews with 13 nurses and reviewing of 38 related articles and the psychometric validation.

RESULTS

The initial item pool contained 62 items. The psychometric properties was examined and exploratory factor analysis revealed a four-factor structure. Risk Factors of Compassion Fatigue Inventory (RFCFI) contained 20 items. The Cronbach's alpha, intra-class correlation coefficient (ICC), and standard error of measurement (SEM) were .86, 0.83, and 5.73 respectively.

CONCLUSION

RFCFI is a short, self-reporting, valid, and reliable inventory for determining the risk factors of compassion fatigue in nurses and can be easily used by managers, nurses, and scholars.

Secondary traumatic stress among emergency nurses: Prevalence, predictors, and consequences

BACKGROUND

Nurses working in emergency units are in direct contact with traumatic events. Trauma effects do not solely affect patients and their caregivers and, rather, extend to secondarily influence nurses themselves. Secondary exposure to trauma may result in symptoms similar to symptoms experienced by the patient themselves. No previous study investigated the secondary traumatic stress among emergency nurses in Jordan.

PURPOSE

To identify prevalence, predictors, and consequences of secondary traumatic stress among nurses working in emergency departments.

METHOD

A descriptive correlation design was utilized to collect data using self-report questionnaires from 202 nurses working at eight emergency departments in Jordan.

FINDINGS

The study revealed that almost half of the sample reported high to severe levels of secondary traumatic stress. The analyses showed that nurses who demonstrated lower empathy (P = .016) and greater coping capacity (P < .001) tended to develop more secondary traumatic stress. Organizational factors were not significant predictors of secondary traumatic stress.

CONCLUSION

A significant proportion of emergency nurses suffer secondary traumatic stress that is found also to be associated with psychical factors. Emergency nurses need to consider the consequences of secondary traumatic stress on their health and quality of care provided.

An exploratory study on the factors affecting the mental health and well-being of frontline workers in homeless services

Frontline workers in homeless services work in a high-intensity, emotionally consuming environment, with frequent exposure to traumatic material with potentially significant consequences for their own mental health. This, in turn, may have a negative impact on the quality of care provided to homeless service users. Prevention of this trajectory may be achieved through psychologically informed environments for staff. This study aimed to explore factors that may influence the development of burnout, secondary traumatic stress (STS), depression, anxiety and stress in this population. Elevated levels of burnout and STS were predicted, as was an association between the predictor variables of professional experience, educational background, continuing professional development, access to organisational support structures and the outcome measures of compassion satisfaction, burnout, STS, depression, anxiety and stress. An online cross-sectional survey design using the Professional Quality of Life Scale (Version V) and the Depression Anxiety and Stress Scale-21 and scales designed for this study capturing occupational variables were distributed via email and national networks to a wide range of services across Scotland and the rest of the UK. Over 4 months in 2017, 112 frontline homelessness workers in health, social care and third sector organisations completed the survey. Results did not indicate elevated levels of burnout or STS, though depression and stress were found to be significantly elevated compared to population norms and were associated with burnout, compassion satisfaction and secondary traumatic stress. High levels of various types of supervision support and CPD were identified. There was no association between these and burnout or stress. We highlight the elevated levels of stress and depression and make a research recommendation to parse types of supervision to assess for optimal effectiveness and efficiency in ensuring that staff working in high-stress homelessness settings receive optimal support to deliver high quality services.

Supporting Those Who Provide Support: Work-Related Resources and Secondary Traumatic Stress Among Victim Advocates

Background/Aims

Victim advocates are at risk of developing secondary traumatic stress (STS), which can result from witnessing or listening to accounts of traumatic events. This study investigated the relationship between victim status, years of experience, hours of direct contact with victims, and availability of workplace supports in the development of STS.

Results

Of the 142 victim advocates, 134 were women. Regression analyses revealed that the only significant predictor of STS was the number of direct hours of victim services provided.

Conclusion

The findings from this study found that women have high rates of STS and that more workplace support needs to be implemented.

Are parents at a higher risk for secondary traumatic stress?: How interviewing child victims impacts relationships with forensic interviewer's friends and family

BACKGROUND

Forensic interviewers are at a heightened risk for secondary traumatic stress (STS) due to their frequent interactions with victims of child maltreatment (Bonach & Heckert, 2012). To date, however, few studies have examined the negative effects of this work on interviewers' social and emotional well-being.

OBJECTIVE

The present study seeks to explore the effect of STS on the relationships of forensic interviewers, including those with friends, family, and their respective children.

PARTICIPANTS AND SETTING

Data are derived from a sample of 367 forensic interviewers (FIs) recruited from across the United States.

METHODS

The current study used a cross-sectional research design to obtain qualitative and quantitative data from an online survey of certified forensic interviewers.

RESULTS

Personal-level predictors of STS included interviewers' sex (β = 0.11, p = 0.02), trauma history (β = 0.13, p = 0.004), and frequency of socializing with family members outside of work (β = -0.12, p = 0.01). Work-related predictors included the frequency of direct (β = 0.10, p = 0.04) and indirect exposures to graphic details of child maltreatment (β = 0.09, p = 0.05), burnout (β = 0.58, p = 0.000), and years of experience investigating crimes against children (β = 0.10, p = 0.03). Factors such as parental status and external social support were not significantly associated with STS in the qualitative analysis.

CONCLUSIONS

Forensic interviewers experience both positive and negative effects of exposure to crimes against children, with work-related factors being particularly impactful on the potential for STS.

Clinicians' Empathy and Professional Quality of Life

Psychotherapists can experience emotional drain as a result of their work with distressed and traumatized patients. It has been suggested that psychotherapists' empathy, which is central to clinical work, may be an important risk factor in the development of burnout or secondary traumatic stress. This apparent contradiction is thought provoking, especially given the complexity of empathic response. The current study aimed to explore the relationship of empathy to compassion satisfaction, burnout, and secondary traumatic stress, while also considering the influence of important work conditions. To do so, 240 psychotherapists described their current practice and reported their levels of empathy and their professional quality of life. Results revealed various relationships between dimensions of empathy and professional quality of life, and the moderating role of empathy regarding the impact of work conditions on professional quality of life. Results highlight the importance of a multidimensional assessment of empathy and the importance of different training and supervision strategies that could help psychotherapists to be more resilient in their work.

Judicial stress: the roles of gender and social support

Because judges experience a myriad of occupational stressors, they are at risk of experiencing secondary trauma, burnout, negative mental/physical health, poor job performance and low job satisfaction. These experiences might not be uniform, however, as gender and social support might mitigate such stress-related outcomes. Judges from two states in the United States completed a variety of stress and subjective performance measures. Social support was related to less perceived stress, less burnout, and more job satisfaction, but only for males. This suggests that males and females might receive qualitatively different types of social support. Different types of social support could differ in their ability to buffer judges from these stress-related outcomes. Further, among judges with high social support, females scored higher than males on subjective job performance; the opposite pattern occurred for judges with low social support. Thus, a lack of social support appears to have a negative effect on performance self-appraisals but only for females. Results have implications for the psychological study of stress and for programs designed to reduce judges' stress.

Secondary Traumatic Stress and Burnout Among Refugee Resettlement Workers: The Role of Coping and Emotional Intelligence

To promote a better understanding of the impact of refugee resettlement work on refugee resettlement workers, this study examined the prevalence rates of deleterious mental health and occupational outcomes, such as secondary traumatic stress and burnout, among a sample of 210 refugee resettlement workers at six refugee resettlement agencies in the United States. The study also explored coping mechanisms used by service providers to manage work-related stress and the influence of such strategies and emotional intelligence on secondary traumatic stress and burnout. Our findings show that certain coping strategies, including self-distraction, humor, venting, substance use, behavioral disengagement, and self-blame, were strongly related to deleterious outcomes, βs = .18 to .38, ps = .023 to < .001. Emotional intelligence was a negative correlate for all outcomes, βs = -.25 to -.30, ps < .001, above and beyond the effects of trauma, coping styles, job, and demographic characteristics. These findings have potential implications for clinical training and organizational policy regarding refugee mental health.

Job-Related Stress in Forensic Interviewers of Children with Use of Therapy Dogs Compared with Facility Dogs or No Dogs

Sexually abused children providing essential testimony regarding crimes in forensic interviews now sometimes are provided facility dogs or therapy dogs for comfort. Facility dogs are extensively trained to work with forensic interviewers; when using therapy dogs in interviews, volunteers are the dog handlers. Interviews can impact child welfare workers' mental health causing secondary traumatic stress (STS). To investigate this stress, first data were gathered on stress retrospectively for when interviewers initially started the job prior to working with a dog, and then currently, from forensic interviewers using a facility dog, a therapy or pet dog, or no dog. These retrospective and secondary traumatic stress scale (STSS) data compared job stress among interviewers of children using: a certified, workplace facility dog (n = 16), a volunteer's trained therapy dog or the interviewer's pet dog (n = 13/3), or no dog (n = 198). Retrospective scores of therapy dog and no dog interviewers' stress were highest for the first interviewing year 1 and then declined. Extremely or very stressful retrospective scores differed among the three groups in year 1 (p < 0.038), and were significantly elevated for the therapy dog group as compared with the facility dog group (p < 0.035). All interviewing groups had elevated STSS scores; when compared with other healthcare groups that have been studied, sub-scores were especially high for Avoidance: a psychological coping mechanism to avoid dealing with a stressor. STSS scores differed among groups (p < 0.016), primarily due to Avoidance sub-scores (p < 0.009), reflecting higher Avoidance scores for therapy dog users than no dog users (p < 0.009). Facility dog users more consistently used dogs during interviews and conducted more interviews than therapy/pet dog users; both groups favored using dogs. Interviewers currently working with therapy dogs accompanied by their volunteers reported they had experienced heightened stress when they began their jobs; their high stress levels still persisted, indicating lower inherent coping skills and perhaps greater empathy among interviewers who later self-selected to work with therapy dogs. Results reveal extreme avoidant stress for interviewers witnessing children who are suffering and their differing coping approaches.

Heart rate variability associated with posttraumatic stress disorder in victims' families of sewol ferry disaster

Posttraumatic stress disorder (PTSD), which is caused by a major traumatic event, has been associated with autonomic nervous function. However, there have been few explorations of measuring biological stress in the victims' family members who have been indirectly exposed to the disaster. Therefore, this longitudinal study examined the heart rate variability (HRV) of the family members of victims of the Sewol ferry disaster. We recruited 112 family members of victims 18 months after the disaster. Sixty-seven participants were revisited at the 30 months postdisaster time point. HRV and psychiatric symptoms including PTSD, depression and anxiety were evaluated at each time point. Participants with PTSD had a higher low frequency to high frequency ratio (LF:HF ratio) than those without PTSD. Logistic regression analysis showed that the LF:HF ratio at 18 months postdisaster was associated with a PTSD diagnosis at 30 months postdisaster. These results suggest that disrupted autonomic nervous system functioning for longer than a year after trauma exposure contributes to predicting PTSD vulnerability. Our finding may contribute to understand neurophysiologic mechanisms underlying secondary traumatic stress. Future studies will be needed to clarify the interaction between autonomic regulation and trauma exposure.

Secondary traumatic stress and secondary posttraumatic growth in a sample of Dutch police family liaison officers

This study investigated secondary traumatic stress (STS) and secondary posttraumatic growth (SPG) in a sample of Dutch police family liaison officers (N = 224). Our study had two aims: (a) to identify potential risk and protective factors for STS and (b) to investigate the association between STS and SPG. None of the risk (caseload and a personal trauma history) and protective factors (age, work experience, and support by supervisors and coworkers) identified in previous research correlated with STS. However, a small positive association was found between STS and SPG. In the discussion section we warn against the use of interventions that aim to prevent STS until more is known about risk and protective factors for STS and provide directions for future research.

Veterans are not the only ones suffering from posttraumatic stress symptoms: what do we know about dependents' secondary traumatic stress?

PURPOSE

Previous research has mainly focused on veterans' mental health problems, especially on posttraumatic stress disorder (PTSD). Less is known about the impact that the veteran's experienced potentially traumatic events (PTEs) might have on their significant others. Therefore, we reviewed the scientific literature to find out what is known about the prevalence of secondary traumatic stress (STS) in significant others of veterans.

METHODS

We systematically searched Pubmed, PsycINFO, Embase, Cochrane Library and PILOTS for relevant articles. This search resulted in 3100 records from which we included 48 articles.

RESULTS

Two studies that reported on parental PTSD did not find evidence that parents were affected by their offspring's experience. Nine studies that reported on PTSD in mainly adult children of veterans found only scant evidence that children were affected by their parent's experienced PTE. Twenty-seven studies investigated PTSD symptoms in partners of veterans. Here results varied largely between studies with PTSD rates between 0 and 51 %.

CONCLUSIONS

Overall, we found the strongest evidence of STS in partners of help-seeking veterans with PTSD. The lack of clarity provided by the currently available evidence suggests a pressing need for further work to examine this subject in more detail.

Effects of Internet-Based Self-Efficacy Intervention on Secondary Traumatic Stress and Secondary Posttraumatic Growth among Health and Human Services Professionals Exposed to Indirect Trauma

Background: Although the evidence for the associations among self-efficacy, secondary traumatic stress (STS) and secondary posttraumatic growth (SPTG) is mounting, there is a lack of the experimental evidence for the influence of self-efficacy on positive and negative mental health outcomes among professionals indirectly exposed to trauma.

Purpose: This study investigated the effects of an internet-based self-efficacy intervention (the experimental condition), compared to an education (the active control condition) on STS and SPTG among workers exposed to traumatic events indirectly, through their clients. We hypothesized that the group assignment (experimental vs. control) would affect STS and SPTG indirectly, with a mediating role of self-efficacy beliefs.

Methods: Participants were 168 health and human services professionals (78% women), exposed indirectly to a traumatic event at work. They were randomly assigned to either a 4-session internet-based self-efficacy intervention (n = 87) or an education control group (n = 81) which received information about coping resources and consequences of stressors at work or at home. STS, SPTG, and self-efficacy were measured at the baseline (Time 1), 1-month follow-up (Time 2) and 2-month follow-up (Time 3).

Results: Analysis of covariance showed that the group assignment had a significant effect on STS (Time 2) and self-efficacy (Time 2), with lower STS and higher self-efficacy reported by the self-efficacy intervention participants. Compared to the experimental group, the active control (education) group participants reported higher SPTG at Time 2. Mediation analyses indicated that the group assignment had indirect effects on STS and SPTG at Time 3. Workers who experienced increases in self-efficacy (Time 2) through the intervention were more likely to report lower STS and higher SPTG at Time 3.

Conclusion: Elucidating the mediating processes that explain why an intervention for secondary trauma works is essential in order to develop more effective support systems that promote improved mental health outcomes among health and human services professionals. Prevention programs for workers exposed indirectly to traumatic events may target self-efficacy enhancement and education.